Provider Demographics
NPI:1255482816
Name:CENTER FOR HAND & EXTREMITY RECONSTRUCTIVE SURGERY, PLC
Entity Type:Organization
Organization Name:CENTER FOR HAND & EXTREMITY RECONSTRUCTIVE SURGERY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-457-1490
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1330
Mailing Address - Country:US
Mailing Address - Phone:248-352-4263
Mailing Address - Fax:248-352-2915
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1330
Practice Address - Country:US
Practice Address - Phone:248-352-4263
Practice Address - Fax:248-352-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056308207XS0106X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F324290OtherBCBS DME PIN
MI0N87170Medicare PIN
MI540F324290OtherBCBS DME PIN
MI5222850001Medicare NSC