Provider Demographics
NPI:1871574269
Name:ANN ARBOR ORTHOPAEDIC SPECIALISTS,P.C.
Entity type:Organization
Organization Name:ANN ARBOR ORTHOPAEDIC SPECIALISTS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DENZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-712-0655
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8634
Mailing Address - Country:US
Mailing Address - Phone:734-712-0655
Mailing Address - Fax:734-712-0611
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 304
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-712-0655
Practice Address - Fax:734-712-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200H113250OtherBLUE CROSS BLUE SHIELD
MI0P21160Medicare PIN