MEDICARE: ORTHOPEDIC TRAUMA SPECIALISTS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0801X	Orthopaedic Trauma Physician	012323	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2058218714	OTHER	MI	BLUE CROSS BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1013185966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC TRAUMA SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48332-0737
Country	:	US
Telephone Number	:	248-697-9839
Fax Number	:

Provider Business Practice Location Address
First Line	:	25500 MEADOWBROOK RD
Second Line	:	SUITE 275
City	:	NOVI
State	:	MI
Zip	:	48375-1878
Country	:	US
Telephone Number	:	248-381-5778
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROBERT P COLEN
Credential	:	D.O.
Telephone Number	:	248-697-9839

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	03/30/2011

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