Provider Demographics
NPI:1700839271
Name:KNEE AND ORTHOPAEDIC CENTER OF LAPEER PC
Entity Type:Organization
Organization Name:KNEE AND ORTHOPAEDIC CENTER OF LAPEER PC
Other - Org Name:KNEE AND ORTHOPAEDIC CENTER OF LAPEER PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-664-3721
Mailing Address - Street 1:1245 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1346
Mailing Address - Country:US
Mailing Address - Phone:810-664-3721
Mailing Address - Fax:810-664-3032
Practice Address - Street 1:1245 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1346
Practice Address - Country:US
Practice Address - Phone:810-664-3721
Practice Address - Fax:810-664-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICH9880OtherTRAVELERS MEDICARE
MI200D410090OtherBCBSM GROUP NUMBER
MI0D41009OtherBLUE CARE NETWORK GROUP
MI200D410090OtherBCBSM GROUP NUMBER