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Organization

ORTHOPEDIC MEDICAL RECREATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IRIS LENA WINCHESTER (DIRECTOR OF OPERATIONS)
(248) 595-8800
Entity
Organization

Contact information

Practice address
15600 W 12 MILE RD, SOUTHFIELD, MI 48076-3068
(248) 595-8800
(248) 595-8517
Mailing address
15600 W 12 MILE RD, SOUTHFIELD, MI 48076-3068
(248) 595-8800
(248) 595-8517

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
261QA0600X
Adult Day Care Clinic/Center
Primary
261QH0100X
Health Service Clinic/Center
261QP3300X
Pain Clinic/Center

Other

Enumeration date
05/02/2013
Last updated
05/02/2013
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