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General NPI Number Information
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NPI Number | 1427767276
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Entity Type | Organization
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Legal Business Name | ORTHODETROIT PLLC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 24715 LITTLE MACK AVE STE 100
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3207
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Country | US
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Telephone | 586-204-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 BOWERS ST UNIT 1110
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City | BIRMINGHAM
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State | MI
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Zip | 48012-7044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER KOZIARA
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Credential | MD
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Telephone | 248-971-0445
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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 |
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License Number State |
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