MEDICARE: TRI COUNTY ORTHOPEDICS PC

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	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5816050001	OTHER	MI	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200F313050	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1134115991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI COUNTY ORTHOPEDICS PC

Provider Business Mailing Address
First Line	:	28100 GRAND RIVER AVE
Second Line	:	SUITE 209
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5967
Country	:	US
Telephone Number	:	248-474-5081
Fax Number	:	248-474-4679

Provider Business Practice Location Address
First Line	:	28100 GRAND RIVER AVE
Second Line	:	SUITE 209
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5967
Country	:	US
Telephone Number	:	248-474-5081
Fax Number	:	248-474-4679

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LINDA LEE HOLTZMAN
Credential	:
Telephone Number	:	248-474-5081

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	06/26/2008

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Directions to “TRI COUNTY ORTHOPEDICS PC ” Practice Location

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