Healthcare Provider Details

I. General information

NPI: 1184175812
Provider Name (Legal Business Name): JERRY ORTHOPAEDIC INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FORT ST SUITE 100
PORT HURON MI
48060-3941
US

IV. Provider business mailing address

2009 RIVER RD
SAINT CLAIR MI
48079-4251
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9871
  • Fax: 810-987-6070
Mailing address:
  • Phone: 810-329-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD J JERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-987-9871