Provider Demographics
NPI:1902006927
Name:LIVINGSTON COUNTY ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:LIVINGSTON COUNTY ORTHOPEDICS, PC
Other - Org Name:LIVINGSTON COUNTY ORTHOPEDICS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-546-7442
Mailing Address - Street 1:820 BYRON RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1072
Mailing Address - Country:US
Mailing Address - Phone:517-546-7442
Mailing Address - Fax:517-546-7596
Practice Address - Street 1:820 BYRON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1072
Practice Address - Country:US
Practice Address - Phone:517-546-7442
Practice Address - Fax:517-546-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH036662207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM76540Medicare PIN