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General NPI Number Information
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NPI Number | 1881613040
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Entity Type | Organization
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Legal Business Name | SPECIALISTS IN ORTHOPEDIC SURGERY PLLC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 1 WILLIAM CARLS DR RSC @ HVSH
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-2201
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Country | US
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Telephone | 248-937-4947
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Fax | 248-937-5150
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Provider Business Mailing Address
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Address Line | 1 WILLIAM CARLS DR RSC @ HVSH
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-2201
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Country | US
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Telephone | 248-937-4947
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Fax | 248-937-5150
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Authorized Official
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Title or Position | BILLER
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Name | MARY HATHORNE
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Credential |
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Telephone | 248-937-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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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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