Provider Demographics
NPI:1790814986
Name:ADVANCED ORTHOPEDIC PLLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WARSHEFSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-985-9365
Mailing Address - Street 1:1231 PINE GROVE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3500
Mailing Address - Country:US
Mailing Address - Phone:810-985-4300
Mailing Address - Fax:810-985-9320
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-985-4300
Practice Address - Fax:810-985-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty