Provider Demographics
NPI:1720395205
Name:MENDELSON ORTHOPEDICS PC
Entity Type:Organization
Organization Name:MENDELSON ORTHOPEDICS PC
Other - Org Name:MENDELSON KORNBLUM ORTHOPEDIC AND SPINE SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-542-0200
Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-261-1960
Mailing Address - Fax:586-582-9805
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-261-1960
Practice Address - Fax:586-582-9805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENDELSON ORTHOPEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM050325207X00000X
MIJM054943207X00000X
MISM072970207X00000X
MIFZ074815207X00000X
MIMK063387207XS0117X
MIAM065335207XS0117X
MI5101014513208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty