Provider Demographics
NPI:1962690941
Name:ORTHOPEDIC INSTITUTE OF MICHIGAN PLLC
Entity type:Organization
Organization Name:ORTHOPEDIC INSTITUTE OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-464-0400
Mailing Address - Street 1:37669 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-464-0400
Mailing Address - Fax:734-464-0404
Practice Address - Street 1:39000 7 MILE RD STE 2500
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1006
Practice Address - Country:US
Practice Address - Phone:734-464-0400
Practice Address - Fax:734-464-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI54-0-H2-2486-0174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI54-0-H2-2486-0OtherDME PROVIDER NUMBER
MI5247500001Medicare NSC