Healthcare Provider Details

I. General information

NPI: 1164719134
Provider Name (Legal Business Name): BRETT ERIC ETCHEBARNE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE SPARROW HOSPITAL
LANSING MI
48912
US

IV. Provider business mailing address

804 SERVICE RD A201
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301099282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: