Healthcare Provider Details

I. General information

NPI: 1144628009
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES OF PORT HURON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 RIVER CENTRE DR
PORT HURON MI
48060-4463
US

IV. Provider business mailing address

940 RIVER CENTRE DR
PORT HURON MI
48060-4463
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-4900
  • Fax: 810-985-3634
Mailing address:
  • Phone: 810-985-4900
  • Fax: 810-985-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN J HEITHOFF
Title or Position: PHYSICIANS
Credential: DO
Phone: 810-985-4900