Provider Demographics
NPI:1669459269
Name:MICHIGAN ORTHOPEDIC SERVICES LLC
Entity Type:Organization
Organization Name:MICHIGAN ORTHOPEDIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-513-8205
Mailing Address - Street 1:13450 FARMINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4207
Mailing Address - Country:US
Mailing Address - Phone:734-513-8205
Mailing Address - Fax:734-513-8219
Practice Address - Street 1:G1213 N. BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4435
Practice Address - Country:US
Practice Address - Phone:810-239-7475
Practice Address - Fax:810-239-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3220750Medicaid
MI3220750Medicaid