Provider Demographics
NPI:1669542247
Name:DEARBORN ORTHOPEDICS & SPORTS MEDICINE P.C.
Entity type:Organization
Organization Name:DEARBORN ORTHOPEDICS & SPORTS MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PLAGENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-730-0500
Mailing Address - Street 1:23550 PARK
Mailing Address - Street 2:SUITE #100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-730-0500
Mailing Address - Fax:313-730-0606
Practice Address - Street 1:23550 PARK
Practice Address - Street 2:SUITE #100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-730-0500
Practice Address - Fax:313-730-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q24704Medicare ID - Type Unspecified