Healthcare Provider Details

I. General information

NPI: 1992703201
Provider Name (Legal Business Name): NORTHWEST ORTHOTICS PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39830 GRAND RIVER AVE SUITE B1D
NOVI MI
48375-2140
US

IV. Provider business mailing address

39830 GRAND RIVER AVE SUITE B1D
NOVI MI
48375-2140
US

V. Phone/Fax

Practice location:
  • Phone: 248-477-1443
  • Fax: 248-477-1509
Mailing address:
  • Phone: 248-477-1443
  • Fax: 248-477-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberB ME 0149837
License Number StateMI

VIII. Authorized Official

Name: MR. GREG V GREENWAY
Title or Position: GENERAL MANAGER, CERTIFIED PROSTHE
Credential: CP
Phone: 248-477-1443