Provider Demographics
NPI:1821281775
Name:ADVANCED ORTHOPAEDIC SPECIALISTS OF ORANGE COUNTY
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SPECIALISTS OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-8558
Mailing Address - Street 1:31862 COAST HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6769
Mailing Address - Country:US
Mailing Address - Phone:949-499-8226
Mailing Address - Fax:949-499-2430
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6769
Practice Address - Country:US
Practice Address - Phone:949-499-8226
Practice Address - Fax:949-499-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
CA137894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6232510001Medicare NSC
CABE555AMedicare PIN