Provider Demographics
NPI:1164690350
Name:RIVER DISTRICT ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:RIVER DISTRICT ORTHOPEDIC SURGERY AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-329-6624
Mailing Address - Street 1:4014 S RIVER RD
Mailing Address - Street 2:BLDG 1A
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-2916
Mailing Address - Country:US
Mailing Address - Phone:810-329-6624
Mailing Address - Fax:810-329-6538
Practice Address - Street 1:4014 S RIVER RD
Practice Address - Street 2:BLDG 1A
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2916
Practice Address - Country:US
Practice Address - Phone:810-329-6624
Practice Address - Fax:810-329-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS007501207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1718278Medicaid
MIE33199Medicare UPIN
MI9740027Medicare PIN