Provider Demographics
NPI:1316184278
Name:ORTHOPEDIC SURGERY OF MACOMB PLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY OF MACOMB PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-226-7400
Mailing Address - Street 1:16570 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1106
Mailing Address - Country:US
Mailing Address - Phone:586-226-7400
Mailing Address - Fax:586-226-2970
Practice Address - Street 1:16570 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1106
Practice Address - Country:US
Practice Address - Phone:586-226-7400
Practice Address - Fax:586-226-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010735207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF85670Medicare UPIN