Healthcare Provider Details

I. General information

NPI: 1093937104
Provider Name (Legal Business Name): MICHIGAN ORTHOPEDIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 NORTHLINE RD.
SOUTHGATE MI
48195-2333
US

IV. Provider business mailing address

13450 FARMINGTON ROAD
LIVONIA MI
48150-4207
US

V. Phone/Fax

Practice location:
  • Phone: 734-530-0101
  • Fax: 734-530-0102
Mailing address:
  • Phone: 734-513-8205
  • Fax: 734-293-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOE CONDON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 734-513-8205