Healthcare Provider Details

I. General information

NPI: 1104094275
Provider Name (Legal Business Name): MID-MICHIGAN ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E STURGIS ST SUITE 9
SAINT JOHNS MI
48879-2068
US

IV. Provider business mailing address

113 E WILLIAMS ST
OWOSSO MI
48867-2360
US

V. Phone/Fax

Practice location:
  • Phone: 989-227-1371
  • Fax: 989-224-3824
Mailing address:
  • Phone: 989-725-6101
  • Fax: 989-723-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH E PALAZETI
Title or Position: PRESIDENT
Credential: DO
Phone: 989-725-6101