Provider Demographics
NPI:1184126906
Name:PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC
Entity type:Organization
Organization Name:PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-618-5555
Mailing Address - Street 1:PERFORMANCE ORTHOPEDICS OF MICHIGAN PLLC PO BOX 771060
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:615-618-5555
Mailing Address - Fax:248-792-4110
Practice Address - Street 1:27207 LAHSER RD STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8470
Practice Address - Country:US
Practice Address - Phone:482-792-4100
Practice Address - Fax:248-792-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty