Healthcare Provider Details

I. General information

NPI: 1013984236
Provider Name (Legal Business Name): DAVID BRYANT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 WOODWARD AVE SUITE 200C
DETROIT MI
48201-2007
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400- CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-4645
  • Fax: 313-993-4654
Mailing address:
  • Phone: 313-745-4525
  • Fax: 313-745-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301058041
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301058041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: