Provider Demographics
NPI:1891473450
Name:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Entity type:Organization
Organization Name:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SIGURDSON-HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:26750 PROVIDENCE PKWY STE 220
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1212
Practice Address - Country:US
Practice Address - Phone:248-596-0412
Practice Address - Fax:248-596-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty