MEDICARE: ABOVE AND BEYOND ORTHOPEDICS LLC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1801121249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE AND BEYOND ORTHOPEDICS LLC

Provider Business Mailing Address
First Line	:	525 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	859-229-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-4324
Country	:	US
Telephone Number	:	859-229-0760
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YAVONNE M MITCHELL-MONEY
Credential	:	BOCCP
Telephone Number	:	859-229-0760

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	06/18/2012

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