Healthcare Provider Details

I. General information

NPI: 1285025015
Provider Name (Legal Business Name): ROCHESTER KNEE & SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR STE 120
TROY MI
48098
US

IV. Provider business mailing address

3100 CROSS CREEK PKWY STE 200
AUBURN HILLS MI
48326-2776
US

V. Phone/Fax

Practice location:
  • Phone: 248-480-0128
  • Fax:
Mailing address:
  • Phone: 248-377-8000
  • 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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: GARETT SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-484-2110