Provider Demographics
NPI:1528896446
Name:MICHIGAN ORTHOPAEDIC SURGEONS, PLLC
Entity type:Organization
Organization Name:MICHIGAN ORTHOPAEDIC SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COMMITTEE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-845-4381
Mailing Address - Street 1:26211 CENTRAL PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4158
Mailing Address - Country:US
Mailing Address - Phone:248-845-4381
Mailing Address - Fax:
Practice Address - Street 1:29110 INKSTER RD STE 225A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1098
Practice Address - Country:US
Practice Address - Phone:248-663-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty