Healthcare Provider Details

I. General information

NPI: 1326371964
Provider Name (Legal Business Name): MICHIGAN ORTHOPEDIC CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 PATIENT CARE DRIVE
LANSING MI
48911
US

IV. Provider business mailing address

3404 PATIENT CARE DR
LANSING MI
48911-4217
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0200
  • Fax: 517-267-1877
Mailing address:
  • Phone: 517-267-0200
  • Fax: 517-267-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY KAY HART
Title or Position: REVENUE CYCLE MANAGER
Credential: CPC
Phone: 517-267-0200