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Organization

COMMUNITY ORTHOPEDIC SURGERY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SANDRA D BOLTON (BILLING MANAGER)
(734) 712-0635
Entity
Organization

Contact information

Practice address
5315 ELLIOTT DR, SUITE 202, YPSILANTI, MI 48197-8634
(734) 712-0600
(734) 712-0522
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
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
RN043612
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
540D711950
BCBSM DME
MI
01
540H115470
BCBSM DME
MI
Enumeration date
06/10/2006
Last updated
06/20/2008
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