Provider Demographics
NPI:1407428584
Name:THE PORRETTA CENTER FOR ORTHOPAEDIC SURGERY, PLLC
Entity Type:Organization
Organization Name:THE PORRETTA CENTER FOR ORTHOPAEDIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKET PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-241-8622
Mailing Address - Street 1:18444 N 25TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:524 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1410
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:866-939-2673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PORRETTA CENTER FOR ORTHOPAEDIC SURGERY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier