Provider Demographics
NPI:1134115991
Name:TRI COUNTY ORTHOPEDICS PC
Entity Type:Organization
Organization Name:TRI COUNTY ORTHOPEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-474-5081
Mailing Address - Street 1:28100 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5967
Mailing Address - Country:US
Mailing Address - Phone:248-474-5081
Mailing Address - Fax:248-474-4679
Practice Address - Street 1:28100 GRAND RIVER AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5967
Practice Address - Country:US
Practice Address - Phone:248-474-5081
Practice Address - Fax:248-474-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200F313050OtherBCBSM
MI5816050001OtherMEDICARE DME
MI5816050001OtherMEDICARE DME
0M38130Medicare ID - Type Unspecified