Organization
COMMUNITY ORTHOPEDIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA D BOLTON (BILLING MANAGER)
(734) 712-0600
Entity
Organization
Contact information
Practice address
7575 GRAND RIVER RD, SUITE 112, BRIGHTON, MI 48114-9309
(810) 844-7557
(810) 844-7561
Mailing address
5315 ELLIOTT DR, SUITE 202, YPSILANTI, MI 48197-8634
(734) 712-0600
(734) 712-0522
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
MI
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540D711950
BCBSM DME
MI
Enumeration date
09/05/2008
Last updated
09/08/2008
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