1821158387 NPI number — ORTHOPEDIC SPECIALISTS PC

Table of content: (NPI 1821158387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821158387 NPI number — ORTHOPEDIC SPECIALISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC SPECIALISTS PC
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:
1821158387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 FORT STREET
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-675-2640
Provider Business Mailing Address Fax Number:
734-675-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 FORT STREET
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-2640
Provider Business Practice Location Address Fax Number:
734-675-2812
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YURKANIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT - PHYSICIAN
Authorized Official Telephone Number:
734-675-2640

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2088201164 . This is a "BCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14822 . This is a "M CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121478 . This is a "PREFERRED CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7914 . This is a "CAPE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4038287 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 821202 . This is a "PRO CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2088201164 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48781 . This is a "OMNI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 763306 . This is a "PENNSYLVANIA BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121478 . This is a "CARE CHOICES HMO" identifier . This identifiers is of the category "OTHER".




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