Healthcare Provider Details

I. General information

NPI: 1487812665
Provider Name (Legal Business Name): AMY MARIE BRUMMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY MARIE COSNOWSKI M.D.

II. Dates (important events)

Enumeration Date: 05/24/2008
Last Update Date: 05/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST DEPT OF PEDIATRIC ANESTHESIOLOGY
DETROIT MI
48201-2119
US

IV. Provider business mailing address

4575 RAVINEWOOD DR
COMMERCE TOWNSHIP MI
48382-1643
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5535
  • Fax: 313-745-5448
Mailing address:
  • Phone: 248-310-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP1-0031942
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number4301101596
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: