Provider Demographics
NPI:1053627810
Name:TODD E HARBURN SPORTS MEDICINE AND ARTHROSCOPIC ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:TODD E HARBURN SPORTS MEDICINE AND ARTHROSCOPIC ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-908-3360
Mailing Address - Street 1:1841 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1122
Mailing Address - Country:US
Mailing Address - Phone:517-908-3360
Mailing Address - Fax:517-908-3368
Practice Address - Street 1:1841 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1122
Practice Address - Country:US
Practice Address - Phone:517-908-3360
Practice Address - Fax:517-908-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008108207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2583832Medicaid
MI2583832Medicaid
MI0C36068004Medicare PIN