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General NPI Number Information
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NPI Number | 1053945923
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Entity Type | Organization
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Legal Business Name | PURE PERFORMANCE ORTHOPEDICS & SPORTS MEDICINE
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 27207 LAHSER RD STE 108
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2168
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Country | US
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Telephone | 248-792-4100
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Fax | 248-792-4110
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Provider Business Mailing Address
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Address Line | 29155 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1011
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Country | US
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Telephone | 248-792-4100
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Fax | 248-792-4100
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROBERT D SWIFT
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Credential |
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Telephone | 248-792-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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