Provider Demographics
NPI:1205119567
Name:MICHIGAN BONE AND JOINT CENTER
Entity type:Organization
Organization Name:MICHIGAN BONE AND JOINT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPAGNUOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-693-3700
Mailing Address - Street 1:1251 S. LAPEER RD.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360
Mailing Address - Country:US
Mailing Address - Phone:248-693-3700
Mailing Address - Fax:248-693-3742
Practice Address - Street 1:1251 S. LAPEER RD.
Practice Address - Street 2:SUITE #102
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360
Practice Address - Country:US
Practice Address - Phone:248-693-3700
Practice Address - Fax:248-693-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015054207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty