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General NPI Number Information
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NPI Number | 1497578579
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Entity Type | Organization
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Legal Business Name | PG ORTHOPAEDICS, PLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 843-536-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 19541 RENFREW RD
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City | DETROIT
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State | MI
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Zip | 48221-1884
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Country | US
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Telephone | 843-536-2044
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PETRA GHERAIBEH
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Credential | MD
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Telephone | 843-536-2044
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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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