Healthcare Provider Details

I. General information

NPI: 1518148741
Provider Name (Legal Business Name): COMMUNITY ORTHOPEDIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 ELLIOTT DR SUITE 202
YPSILANTI MI
48197-8634
US

IV. Provider business mailing address

5315 ELLIOTT DR SUITE 202
YPSILANTI MI
48197-8634
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-0600
  • Fax:
Mailing address:
  • Phone: 734-712-0600
  • Fax:

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: MRS. SANDRA DEE BOLTON
Title or Position: BILLING MANAGER
Credential:
Phone: 734-712-0635