Provider Demographics
NPI:1467783704
Name:MICHIGAN HIP AND KNEE REPLACEMENT
Entity Type:Organization
Organization Name:MICHIGAN HIP AND KNEE REPLACEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:DE BEAUBIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-921-3500
Mailing Address - Street 1:4701 TOWNE CTR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2834
Mailing Address - Country:US
Mailing Address - Phone:989-921-3500
Mailing Address - Fax:989-921-3501
Practice Address - Street 1:4701 TOWNE CTR
Practice Address - Street 2:SUITE 301
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-921-3500
Practice Address - Fax:989-921-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBD054539207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4386654Medicaid
MI0N47170Medicare UPIN