Healthcare Provider Details

I. General information

NPI: 1447274725
Provider Name (Legal Business Name): CARA ELIZA BRINZEIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA ELIZA WALLACE MD

II. Dates (important events)

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

III. Provider practice location address

527 COBBS ST CADILLAC
CADILLAC MI
49601-2540
US

IV. Provider business mailing address

527 COBB ST CADILLAC
CADILLAC MI
49601-2540
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-3463
  • Fax:
Mailing address:
  • Phone: 231-775-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301076009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: