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General NPI Number Information
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NPI Number | 1942387998
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Entity Type | Organization
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Legal Business Name | JEFFREY H. DECLAIRE M.D., P.C.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 1135 W UNIVERSITY DR STE 450
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City | ROCHESTER
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State | MI
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Zip | 48307-1871
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Country | US
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Telephone | 248-650-2400
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Fax | 248-650-4596
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Provider Business Mailing Address
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Address Line | PO BOX 9042
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City | BELFAST
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State | ME
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Zip | 04915-9042
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Country | US
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Telephone | 248-650-2400
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Fax | 248-650-4596
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOHN ERNEST LAMACCHIA
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Credential | MD
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Telephone | 248-650-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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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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