Provider Demographics
NPI:1043395262
Name:MT CLEMENS ORTHOPAEDIC APPLIANCES INC
Entity Type:Organization
Organization Name:MT CLEMENS ORTHOPAEDIC APPLIANCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHROETER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:586-463-3500
Mailing Address - Street 1:24432 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-463-3600
Mailing Address - Fax:586-463-6337
Practice Address - Street 1:24432 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-463-3600
Practice Address - Fax:586-463-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI641OtherBLUE CARE NET
MI2712116 TYPE 85Medicaid
MIOE00690OtherBLUE CROSS
MI641OtherBLUE CARE NET