MEDICARE: DR. BARRY D. BRONSTEIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101007671	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699767475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY D. BRONSTEIN D.O.

Provider Business Mailing Address
First Line	:	27774 FRANKLIN RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-2352
Country	:	US
Telephone Number	:	248-356-5555
Fax Number	:	248-356-5544

Provider Business Practice Location Address
First Line	:	8305 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2231
Country	:	US
Telephone Number	:	313-894-1900
Fax Number	:	313-894-4206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/19/2012

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