Healthcare Provider Details

I. General information

NPI: 1245310424
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC PROFESSIONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOODLAND PASS SUITE E
EAST LANSING MI
48823
US

IV. Provider business mailing address

PO BOX 80
GREGORY MI
48137-0080
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-0304
  • Fax: 517-333-7074
Mailing address:
  • Phone: 517-333-0304
  • Fax: 517-333-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RONALD WILLIAM SUTTON
Title or Position: OWNER
Credential: AMERICAN BOARD CERTI
Phone: 517-333-0304