Healthcare Provider Details

I. General information

NPI: 1801434873
Provider Name (Legal Business Name): BRETT ALAN MCMAHON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

29944 MACINTOSH LN
NEW HUDSON MI
48165-8906
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-3300
  • Fax:
Mailing address:
  • Phone: 248-763-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704293922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: