Provider Demographics
NPI:1609831775
Name:ORTHOPEDIC SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-572-4565
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:STE 301
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8634
Mailing Address - Country:US
Mailing Address - Phone:734-572-4500
Mailing Address - Fax:734-572-4503
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:STE 301
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-572-4500
Practice Address - Fax:734-572-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H16107Medicare PIN
MI0371990001Medicare NSC