Provider Demographics
NPI:1255517272
Name:DMC ORTHOPAEDIC BILLING ASSOCIATES, LLC
Entity type:Organization
Organization Name:DMC ORTHOPAEDIC BILLING ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LACUSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-745-0770
Mailing Address - Street 1:PO BOX 673671
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3671
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-600-1597
Practice Address - Street 1:9398 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4610
Practice Address - Country:US
Practice Address - Phone:734-254-0453
Practice Address - Fax:734-459-1855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMC ORTHOPAEDIC BILLING ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P35120Medicare PIN