Healthcare Provider Details

I. General information

NPI: 1609953355
Provider Name (Legal Business Name): FRENCHTOWN ORTHOPEDIC GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N MONROE ST
MONROE MI
48162-4211
US

IV. Provider business mailing address

1420 N MONROE ST
MONROE MI
48162-4211
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-0042
  • Fax: 734-384-0469
Mailing address:
  • Phone: 734-241-0042
  • Fax: 734-384-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA40131
License Number StateMI

VIII. Authorized Official

Name: DR. ANTHONY EMMANUEL MELONAKOS
Title or Position: PRESIDENT
Credential: MD
Phone: 734-241-0042