Provider Demographics
NPI:1205037694
Name:MICHIGAN SURGERY SPECIALIST DBA TEITGE ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:MICHIGAN SURGERY SPECIALIST DBA TEITGE ORTHOPAEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-751-3380
Mailing Address - Street 1:11012 E 13 MILE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2572
Mailing Address - Country:US
Mailing Address - Phone:586-751-3380
Mailing Address - Fax:586-751-0950
Practice Address - Street 1:3272 E 12 MILE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5622
Practice Address - Country:US
Practice Address - Phone:586-573-3100
Practice Address - Fax:586-573-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT042363207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty