Healthcare Provider Details

I. General information

NPI: 1649319740
Provider Name (Legal Business Name): BEAUMONT ORTHOPAEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE ROAD SUITE 742
ROYAL OAK MI
48073-6770
US

IV. Provider business mailing address

3535 W 13 MILE ROAD SUITE 742
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-9100
  • Fax: 248-551-9131
Mailing address:
  • Phone: 248-551-9100
  • Fax: 248-551-9131

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: HARRY N HERKOWITZ
Title or Position: CHAIRMAN
Credential: MD
Phone: 248-551-9100