Provider Demographics
NPI:1720395205
Name:MENDELSON ORTHOPEDICS PC
Entity type:Organization
Organization Name:MENDELSON ORTHOPEDICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-542-0200
Mailing Address - Street 1:500 STEPHENSON HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1118
Mailing Address - Country:US
Mailing Address - Phone:586-439-6258
Mailing Address - Fax:
Practice Address - Street 1:35735 MOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4728
Practice Address - Country:US
Practice Address - Phone:586-261-1960
Practice Address - Fax:586-261-1961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENDELSON ORTHOPEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM050325207X00000X
MIJM054943207X00000X
MISM072970207X00000X
MIFZ074815207X00000X
MIMK063387207XS0117X
MIAM065335207XS0117X
MI5101014513208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty