Healthcare Provider Details

I. General information

NPI: 1356487870
Provider Name (Legal Business Name): HAND SURGERY OF NORTHERN MICHIGAN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W FRONT ST SUITE 100
TRAVERSE CITY MI
49684-2236
US

IV. Provider business mailing address

701 W FRONT ST SUITE 100
TRAVERSE CITY MI
49684-2236
US

V. Phone/Fax

Practice location:
  • Phone: 231-995-9748
  • Fax: 231-995-9745
Mailing address:
  • Phone: 231-995-9748
  • Fax: 231-995-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE LEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 231-935-0800