Provider Demographics
NPI:1942387998
Name:JEFFREY H. DECLAIRE M.D., P.C.
Entity Type:Organization
Organization Name:JEFFREY H. DECLAIRE M.D., P.C.
Other - Org Name:DECLAIRE LAMACCHIA ORTHOPAEDIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:LAMACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-650-2400
Mailing Address - Street 1:PO BOX 9042
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9042
Mailing Address - Country:US
Mailing Address - Phone:248-650-2400
Mailing Address - Fax:248-650-4596
Practice Address - Street 1:1135 W UNIVERSITY DR STE 450
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-650-2400
Practice Address - Fax:248-650-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34848OtherBLUE CROSS BLUE SHIELD
MI0H70719OtherBLUE CROSS BLUE SHIELD (PHYSICAL THERAPY)
MI1942387998Medicaid