Provider Demographics
NPI:1851877153
Name:MICHIGAN SURGERY SPECIALISTS P.C.
Entity Type:Organization
Organization Name:MICHIGAN SURGERY SPECIALISTS P.C.
Other - Org Name:MOTUS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUDLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-558-9705
Mailing Address - Street 1:11012 E 13 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2547
Mailing Address - Country:US
Mailing Address - Phone:586-558-9705
Mailing Address - Fax:586-558-9706
Practice Address - Street 1:11012 E 13 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2547
Practice Address - Country:US
Practice Address - Phone:586-573-8890
Practice Address - Fax:586-573-2706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN SURGERY SPECIALISTS P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2023-08-25
Deactivation Date:2019-01-07
Deactivation Code:
Reactivation Date:2019-01-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01734OtherBCBSM
MI7626310001OtherMEDICARE