Healthcare Provider Details

I. General information

NPI: 1790771145
Provider Name (Legal Business Name): BRUCE B FEYZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAFTON RD STE 4
NEWPORT MI
48166-8908
US

IV. Provider business mailing address

7505 GRAFTON RD STE 4
NEWPORT MI
48166-8908
US

V. Phone/Fax

Practice location:
  • Phone: 734-586-6311
  • Fax: 734-586-6318
Mailing address:
  • Phone: 734-586-6311
  • Fax: 734-586-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBF036463
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: