Provider Demographics
NPI:1992243703
Name:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Entity type:Organization
Organization Name:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COMMITTEE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODBEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-244-8431
Mailing Address - Street 1:26025 LAHSER RD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2606
Mailing Address - Country:US
Mailing Address - Phone:248-663-1900
Mailing Address - Fax:
Practice Address - Street 1:1350 KIRTS BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4851
Practice Address - Country:US
Practice Address - Phone:248-244-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier