Provider Demographics
NPI:1639681257
Name:MICHIGAN MUSCULOSKELETAL INSTITUTE LLC
Entity Type:Organization
Organization Name:MICHIGAN MUSCULOSKELETAL INSTITUTE LLC
Other - Org Name:MMI
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-209-3353
Mailing Address - Street 1:28037 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3079
Mailing Address - Country:US
Mailing Address - Phone:313-209-3353
Mailing Address - Fax:
Practice Address - Street 1:28037 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3079
Practice Address - Country:US
Practice Address - Phone:313-209-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-05
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty