Healthcare Provider Details

I. General information

NPI: 1679293757
Provider Name (Legal Business Name): DETROIT ORTHOPEDICS & SPORTS MEDICINE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27207 LAHSER RD STE 250
SOUTHFIELD MI
48034-2168
US

IV. Provider business mailing address

PO BOX 145
NOVI MI
48376-0145
US

V. Phone/Fax

Practice location:
  • Phone: 248-595-8518
  • Fax:
Mailing address:
  • Phone: 313-319-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN NZOMA
Title or Position: CEO
Credential:
Phone: 313-319-6858