Provider Demographics
NPI:1447376033
Name:KAMIL ORTHOPAEDIC GROUP PC
Entity type:Organization
Organization Name:KAMIL ORTHOPAEDIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-661-4700
Mailing Address - Street 1:6621 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48357
Mailing Address - Country:US
Mailing Address - Phone:248-661-4700
Mailing Address - Fax:248-661-6210
Practice Address - Street 1:6621 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48357
Practice Address - Country:US
Practice Address - Phone:248-661-4700
Practice Address - Fax:248-661-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010LL043767207RR0500X
MI43010MK045030207X00000X
MI43010MM059872207X00000X
MI5501004058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0635205OtherBLUE CROSS BLUE SHIELD
MI0635205OtherBLUE CROSS BLUE SHIELD
MI0635205OtherBLUE CROSS BLUE SHIELD