Provider Demographics
NPI:1609953355
Name:FRENCHTOWN ORTHOPEDIC GROUP PC
Entity Type:Organization
Organization Name:FRENCHTOWN ORTHOPEDIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:MELONAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-241-0042
Mailing Address - Street 1:1420 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4211
Mailing Address - Country:US
Mailing Address - Phone:734-241-0042
Mailing Address - Fax:734-384-0469
Practice Address - Street 1:1420 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4211
Practice Address - Country:US
Practice Address - Phone:734-241-0042
Practice Address - Fax:734-384-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA40131173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1063350002Medicare NSC