Healthcare Provider Details

I. General information

NPI: 1174776736
Provider Name (Legal Business Name): STEVEN M BRINDAMOUR P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162-7815
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8400
  • Fax:
Mailing address:
  • Phone: 567-585-1918
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: