MEDICARE: RIVER DISTRICT ORTHOPEDIC SURGERY AND SPORTS MEDICINE, 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	MS007501	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

General Provider Information

NPI Number	:	1164690350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER DISTRICT ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC

Provider Business Mailing Address
First Line	:	4014 S RIVER RD
Second Line	:	BLDG 1A
City	:	EAST CHINA
State	:	MI
Zip	:	48054-2916
Country	:	US
Telephone Number	:	810-329-6624
Fax Number	:	810-329-6538

Provider Business Practice Location Address
First Line	:	4014 S RIVER RD
Second Line	:	BLDG 1A
City	:	EAST CHINA
State	:	MI
Zip	:	48054-2916
Country	:	US
Telephone Number	:	810-329-6624
Fax Number	:	810-329-6538

Authorized Official
Title or Position	:	ORTHOPEDIC SURGEON
Name	:	DR. MICHAEL JOSEPH SUTTON
Credential	:	D.O.
Telephone Number	:	810-329-6624

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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