Provider Demographics
NPI:1720160963
Name:PERFORMANCE ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:PERFORMANCE ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-988-8085
Mailing Address - Street 1:24255 W 13 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4320
Mailing Address - Country:US
Mailing Address - Phone:248-988-8085
Mailing Address - Fax:
Practice Address - Street 1:24255 W 13 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4320
Practice Address - Country:US
Practice Address - Phone:248-988-8085
Practice Address - Fax:248-988-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200634970OtherBAK BCBS
2006344541OtherGUETTLER BCBS
2006328361OtherJURIST BCBS
0F32158OtherGROUP BCBS
H52411Medicare UPIN
P2292001Medicare PIN
0N50640Medicare PIN
I43445Medicare UPIN
0P22920Medicare PIN
A73353Medicare UPIN
Y42918Medicare UPIN
O632836Medicare PIN