Basic Information
| Provider Information | |||||||||
| NPI: | 1013256296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCLAREN MACOMB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 39833 BRIDGEVIEW ST | ||||||||
| Address2: | |||||||||
| City: | HARRISON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866272727 | ||||||||
| FaxNumber: | 5866272730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | BRISSE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5864938083 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.