Provider Demographics
NPI:1831366905
Name:ADRIAN ORTHOPEDICS PC
Entity type:Organization
Organization Name:ADRIAN ORTHOPEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-0208
Mailing Address - Street 1:693 STOCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1460
Mailing Address - Country:US
Mailing Address - Phone:517-264-0756
Mailing Address - Fax:
Practice Address - Street 1:693 STOCKFORD DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1460
Practice Address - Country:US
Practice Address - Phone:517-265-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011992207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2054600214OtherBCBS
MI4240749Medicaid
MI4240749Medicaid
MI2054600214OtherBCBS