Provider Demographics
NPI:1649319740
Name:BEAUMONT ORTHOPAEDIC CENTER
Entity type:Organization
Organization Name:BEAUMONT ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-551-9100
Mailing Address - Street 1:3535 W 13 MILE ROAD
Mailing Address - Street 2:SUITE 742
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6770
Mailing Address - Country:US
Mailing Address - Phone:248-551-9100
Mailing Address - Fax:248-551-9131
Practice Address - Street 1:3535 W 13 MILE ROAD
Practice Address - Street 2:SUITE 742
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-9100
Practice Address - Fax:248-551-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37206Medicare ID - Type Unspecified