Organization
ORTHOPAEDIC ASSOCIATES OF MUSKEGON, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORAL FULLER (CREDENTIALING MANAGER)
(231) 830-2729
Entity
Organization
Contact information
Practice address
1400 MERCY DR, STE 100, MUSKEGON, MI 49444-1836
(231) 733-1326
(231) 830-2764
Mailing address
1400 MERCY DR, STE 100, MUSKEGON, MI 49444-1836
(231) 733-1326
(231) 830-2764
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N94170
MEDICARE GROUP PROVIDER #
—
Enumeration date
04/07/2006
Last updated
06/15/2022
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