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General NPI Number Information
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NPI Number | 1164690350
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Entity Type | Organization
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Legal Business Name | RIVER DISTRICT ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 4014 S RIVER RD BLDG 1A
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City | EAST CHINA
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State | MI
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Zip | 48054-2916
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Country | US
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Telephone | 810-329-6624
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Fax | 810-329-6538
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Provider Business Mailing Address
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Address Line | 4014 S RIVER RD BLDG 1A
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City | EAST CHINA
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State | MI
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Zip | 48054-2916
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Country | US
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Telephone | 810-329-6624
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Fax | 810-329-6538
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. MICHAEL JOSEPH SUTTON
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Credential | D.O.
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Telephone | 810-329-6624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MS007501
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License Number State | MI
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