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General NPI Number Information
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NPI Number | 1679293757
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Entity Type | Organization
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Legal Business Name | DETROIT ORTHOPEDICS & SPORTS MEDICINE PLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 27207 LAHSER RD STE 250
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2168
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Country | US
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Telephone | 248-595-8518
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | NOVI
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State | MI
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Zip | 48376-0145
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Country | US
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Telephone | 313-319-6858
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN NZOMA
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Credential |
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Telephone | 313-319-6858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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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