Provider Demographics
NPI:1780990127
Name:APOLLO LIMB & BRACE
Entity type:Organization
Organization Name:APOLLO LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:248-499-8719
Mailing Address - Street 1:2721 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2542
Mailing Address - Country:US
Mailing Address - Phone:248-499-8719
Mailing Address - Fax:248-499-8713
Practice Address - Street 1:2721 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2542
Practice Address - Country:US
Practice Address - Phone:248-499-8719
Practice Address - Fax:248-499-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC26313335E00000X
MICP002840335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6465750001Medicare NSC