Healthcare Provider Details

I. General information

NPI: 1124018833
Provider Name (Legal Business Name): DAVID H MENDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD SUITE 110
WARREN MI
48093-3400
US

IV. Provider business mailing address

11900 E 12 MILE RD SUITE 110
WARREN MI
48093-3400
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7070
  • Fax: 586-582-7066
Mailing address:
  • Phone: 586-582-7070
  • Fax: 586-582-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301050325
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: