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General NPI Number Information
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NPI Number | 1184126906
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Entity Type | Organization
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Legal Business Name | PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 08/06/2020
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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 | 48034-8470
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Country | US
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Telephone | 482-792-4100
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Fax | 248-792-4110
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Provider Business Mailing Address
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Address Line | PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC PO BOX 771060
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 615-618-5555
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Fax | 248-792-4110
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBERT DAVID SWIFT
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Credential | DO
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Telephone | 615-618-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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