Organization
ORTHOTECH ORTHOPEDIC APPLIANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE MICHAEL BUGG CPO (OWNER)
(989) 343-0526
Entity
Organization
Contact information
Practice address
2254 S M 30, WEST BRANCH, MI 48661-8711
(989) 343-0526
(989) 343-0525
Mailing address
2254 S M 30, WEST BRANCH, MI 48661-8711
(989) 343-0526
(989) 343-0525
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
MI
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4759354
—
MI
01
—
530F510320
BLUE CROSS
MI
Enumeration date
02/01/2007
Last updated
09/24/2019
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