=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154519171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPAEDIC CENTER OF MID-MICHIGAN P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 04/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3875 BAY RD STE 2S
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-793-1372
-----------------------------------------------------
Fax | 989-793-4518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3875 BAY RD STE 2S
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-793-1372
-----------------------------------------------------
Fax | 989-793-4518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CAROL M KERN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-793-1372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4301055237
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------