Healthcare Provider Details

I. General information

NPI: 1871600833
Provider Name (Legal Business Name): BRADY T. VIBERT, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOUTH BLVD E SUITE 310
ROCHESTER HILLS MI
48307-5605
US

IV. Provider business mailing address

1555 SOUTH BLVD E SUITE 310
ROCHESTER HILLS MI
48307-5605
US

V. Phone/Fax

Practice location:
  • Phone: 248-215-8095
  • Fax: 248-289-1086
Mailing address:
  • Phone: 248-215-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4301075858
License Number StateMI

VIII. Authorized Official

Name: DR. BRADY T VIBERT
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 248-215-8095