Healthcare Provider Details

I. General information

NPI: 1376500090
Provider Name (Legal Business Name): MICHAEL FULTON BROOKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 EAST GRAND RIVER BRIGHTON HOSPITAL
BRIGHTON MI
48116
US

IV. Provider business mailing address

12851 EAST GRAND RIVER
BRIGHTON MI
48116
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-1211
  • Fax: 810-220-5509
Mailing address:
  • Phone: 810-227-1211
  • Fax: 810-220-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: