Provider Demographics
NPI:1578994737
Name:MENDELSON ORTHOPEDICS
Entity Type:Organization
Organization Name:MENDELSON ORTHOPEDICS
Other - Org Name:MENDELSON KORNBLUM ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-261-1960
Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-261-1960
Mailing Address - Fax:586-261-1961
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-261-1960
Practice Address - Fax:586-261-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty