Provider Demographics
NPI:1295798353
Name:MID MICHIGAN ORTHOPAEDIC INSTITUTE PLLC
Entity type:Organization
Organization Name:MID MICHIGAN ORTHOPAEDIC INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-333-3777
Mailing Address - Street 1:830 W LAKE LANSING RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6371
Mailing Address - Country:US
Mailing Address - Phone:517-333-3777
Mailing Address - Fax:517-203-3948
Practice Address - Street 1:830 W LAKE LANSING RD
Practice Address - Street 2:SUITE 190
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-333-3777
Practice Address - Fax:517-203-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200C313650OtherBLUECARE NETWORK
MI7910818OtherAETNA
MI200C313650OtherBCBS OF MICHIGAN
MI61117320OtherUS DEPT OF LABOR
MI61117320OtherUS DEPT OF LABOR