Healthcare Provider Details

I. General information

NPI: 1598731473
Provider Name (Legal Business Name): JOHN V BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PINE GROVE AVE INFECTIOUS DISEASE, SUITE 1B
PORT HURON MI
48060-3500
US

IV. Provider business mailing address

15474 N HAGGERTY RD
PLYMOUTH MI
48170-4893
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-1993
  • Fax: 810-966-1997
Mailing address:
  • Phone: 734-335-6103
  • Fax: 630-734-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301056328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: