Organization
ASSOCIATED ORTHOPEDISTS OF DETROIT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE JOHNSON (CREDENTIALING MANAGER)
(586) 710-2307
Entity
Organization
Contact information
Practice address
24715 LITTLE MACK AVE, SUITE 100, ST CLAIR SHORES, MI 48080-3207
(586) 779-7970
(586) 779-7748
Mailing address
24715 LITTLE MACK AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-3207
(586) 779-7970
(586) 779-7748
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200E076460
BCBSM PIN
MI
Enumeration date
02/03/2006
Last updated
05/22/2025
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