Provider Demographics
NPI:1679293757
Name:DETROIT ORTHOPEDICS & SPORTS MEDICINE PLC
Entity Type:Organization
Organization Name:DETROIT ORTHOPEDICS & SPORTS MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NZOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-319-6858
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0145
Mailing Address - Country:US
Mailing Address - Phone:313-319-6858
Mailing Address - Fax:
Practice Address - Street 1:27207 LAHSER RD STE 250
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2168
Practice Address - Country:US
Practice Address - Phone:248-595-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty