Provider Demographics
NPI:1689932980
Name:ASSOCITED ORTHOPEDIST OF DETROTI
Entity Type:Organization
Organization Name:ASSOCITED ORTHOPEDIST OF DETROTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-779-0082
Mailing Address - Street 1:24715 LITTLE MACK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3207
Mailing Address - Country:US
Mailing Address - Phone:586-779-7970
Mailing Address - Fax:586-779-7748
Practice Address - Street 1:50505 SCHOENHERR
Practice Address - Street 2:SUITE 140
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48301
Practice Address - Country:US
Practice Address - Phone:586-710-2320
Practice Address - Fax:586-997-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55020000231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty