Provider Demographics
NPI:1114922523
Name:PRIESKORN, DAVID W (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:PRIESKORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:STE 275
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1878
Mailing Address - Country:US
Mailing Address - Phone:248-381-5777
Mailing Address - Fax:248-381-5779
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:STE 275
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-381-5777
Practice Address - Fax:248-381-5779
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIDP010040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2854149Medicaid
F30308Medicare UPIN
MI2854149Medicaid