Organization
SPECIALISTS IN ORTHOPEDIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HATHORNE (BILLER)
(248) 937-3411
Entity
Organization
Contact information
Practice address
1 WILLIAM CARLS DR, RSC @ HVSH, COMMERCE TOWNSHIP, MI 48382-2201
(248) 937-4947
(248) 937-5150
Mailing address
1 WILLIAM CARLS DR, RSC @ HVSH, COMMERCE TOWNSHIP, MI 48382-2201
(248) 937-4947
(248) 937-5150
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F32656
BCBSMI DME SUPPLIER ID#
MI
01
—
0F37461
BCBSMI GROUP ID#
MI
01
—
5606110
ADMINISTAR FEDERAL DME
MI
01
—
5606110003
ADMINISTAR FEDERAL DME
MI
Enumeration date
07/19/2006
Last updated
12/30/2008
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