Provider Demographics
NPI:1104802784
Name:ROPP ORTHOPEDIC CLINIC LLC
Entity type:Organization
Organization Name:ROPP ORTHOPEDIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ROPP
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:248-669-9222
Mailing Address - Street 1:2075 E WEST MAPLE RD
Mailing Address - Street 2:STE B-207
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3816
Mailing Address - Country:US
Mailing Address - Phone:248-669-9222
Mailing Address - Fax:248-669-3866
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:STE B-207
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-669-9222
Practice Address - Fax:248-669-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5183754Medicaid
MI5582740001Medicare NSC