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General NPI Number Information
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NPI Number | 1295905743
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Entity Type | Organization
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Legal Business Name | MICHIGAN ORTHOPEDIC SURGERY AND REHABILITATION, P.C.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 6565 W MAIN ST SUITE 235
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City | KALAMAZOO
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State | MI
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Zip | 49009-6114
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Country | US
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Telephone | 269-544-4715
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Fax | 269-544-4719
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Provider Business Mailing Address
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Address Line | 6565 W MAIN ST SUITE 235
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City | KALAMAZOO
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State | MI
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Zip | 49009-6114
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Country | US
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Telephone | 269-544-4715
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Fax | 269-544-4719
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | PATTI PIERMAN
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Credential |
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Telephone | 269-341-6417
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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 | 4301041296
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License Number State | MI
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