Healthcare Provider Details

I. General information

NPI: 1710713102
Provider Name (Legal Business Name): MENDELSON ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FORT ST STE 100
PORT HURON MI
48060-3942
US

IV. Provider business mailing address

500 STEPHENSON HWY STE 300
TROY MI
48083-1118
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9871
  • Fax:
Mailing address:
  • Phone: 586-439-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID H MENDELSON
Title or Position: PHYSICIAN
Credential:
Phone: 586-261-1960