Provider Demographics
NPI:1245621804
Name:ROCHESTER KNEE & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:ROCHESTER KNEE & SPORTS MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-377-8000
Mailing Address - Street 1:3100 CROSS CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2774
Mailing Address - Country:US
Mailing Address - Phone:248-377-8000
Mailing Address - Fax:248-377-2929
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-377-8000
Practice Address - Fax:248-377-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5148130001Medicare PIN