Wolverine Orthotics, Inc.

Primary specialty

OrthotistTaxonomy code 222Z00000X

Legal business name

WOLVERINE ORTHOTICS, INC.

Practice address

28455 Haggerty Rd
101
Novi, MI 48377-2982

Phone

(248) 324-3010

Fax

(248) 324-3003

NPI assigned

Jul 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ernst Walter Bastian, CO

Title

President

Phone

(248) 324-3010

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1013938455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28455 HAGGERTY RD",
            "address_2": "101",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772982",
            "telephone_number": "248-324-3010",
            "fax_number": "248-324-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28455 HAGGERTY RD",
            "address_2": "101",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772982",
            "telephone_number": "248-324-3010",
            "fax_number": "248-324-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLVERINE ORTHOTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "BASTIAN",
        "authorized_official_first_name": "ERNST",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-324-3010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "510F312100",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "853203750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthotist in Novi, MI
• Providers in Novi, MI by specialty
• Orthotist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.