1013185966 NPI number — ORTHOPEDIC TRAUMA SPECIALISTS PLLC

Table of content: CHELY CRAIG MSW, LCSWA (NPI 1649154188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013185966 NPI number — ORTHOPEDIC TRAUMA SPECIALISTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC TRAUMA SPECIALISTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013185966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48332-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-697-9839
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25500 MEADOWBROOK RD
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48375-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-381-5778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COLEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
248-697-9839

Provider Taxonomy Codes

  • Taxonomy code: 207XX0801X , with the licence number:  012323 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4650148 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2058218714 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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