Healthcare Provider Details

I. General information

NPI: 1942387998
Provider Name (Legal Business Name): JEFFREY H. DECLAIRE M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR STE 450
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

PO BOX 9042
BELFAST ME
04915-9042
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-2400
  • Fax: 248-650-4596
Mailing address:
  • Phone: 248-650-2400
  • Fax: 248-650-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN ERNEST LAMACCHIA
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 248-650-2400