Healthcare Provider Details

I. General information

NPI: 1184126906
Provider Name (Legal Business Name): PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27207 LAHSER RD STE 108
SOUTHFIELD MI
48034-8470
US

IV. Provider business mailing address

PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC PO BOX 771060
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 482-792-4100
  • Fax: 248-792-4110
Mailing address:
  • Phone: 615-618-5555
  • Fax: 248-792-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DAVID SWIFT
Title or Position: DIRECTOR
Credential: DO
Phone: 615-618-5555