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General NPI Number Information
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NPI Number | 1255517272
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Entity Type | Organization
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Legal Business Name | DMC ORTHOPAEDIC BILLING ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 9398 N LILLEY RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-4610
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Country | US
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Telephone | 734-254-0453
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Fax | 734-459-1855
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Provider Business Mailing Address
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Address Line | PO BOX 673671
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City | DETROIT
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State | MI
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Zip | 48267-3671
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Country | US
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Telephone | 810-720-5715
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Fax | 810-600-1597
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Authorized Official
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Title or Position | EXEC VP
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Name | MR. MICHAEL LACUSTA
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Credential |
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Telephone | 313-745-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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