Provider Demographics
NPI:1053625467
Name:ADVANCED ORTHOPEDIC SPECIALISTS PC
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LONIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-299-8550
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:STE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR
Practice Address - Street 2:STE 170
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7004
Practice Address - Country:US
Practice Address - Phone:810-299-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED ORTHOPEDIC SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-28
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site