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General NPI Number Information
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NPI Number | 1639576440
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Entity Type | Organization
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Legal Business Name | THE PORRETTA CENTER FOR ORTHOPAEDIC SURGERY, PLLC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 8273 GRAND RIVER RD STE 210
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City | BRIGHTON
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State | MI
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Zip | 48114-9346
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE STE 310
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City | PHOENIX
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State | AZ
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Zip | 85023-1266
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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Authorized Official
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Title or Position | MARKET PRESIDENT, MICHIGAN
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Name | DAVID MARKEL
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Credential | MD
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Telephone | 866-974-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MI
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