Healthcare Provider Details

I. General information

NPI: 1508782947
Provider Name (Legal Business Name): BEP MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 BAKER RD STE K
DEXTER MI
48130-1163
US

IV. Provider business mailing address

2749 TRAILWOOD LN
ANN ARBOR MI
48105-9743
US

V. Phone/Fax

Practice location:
  • Phone: 734-215-5768
  • Fax: 614-482-4938
Mailing address:
  • Phone: 734-210-1627
  • Fax: 614-482-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCIA BOCKBRADER
Title or Position: OWNER
Credential: MD PHD
Phone: 614-286-0305