Provider Demographics
NPI:1013185966
Name:ORTHOPEDIC TRAUMA SPECIALISTS PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC TRAUMA SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-697-9839
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48332-0737
Mailing Address - Country:US
Mailing Address - Phone:248-697-9839
Mailing Address - Fax:
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:SUITE 275
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-381-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012323207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4650148Medicaid
MI2058218714OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4650148Medicaid
MI4650148Medicaid
0N98690Medicare PIN