Healthcare Provider Details

I. General information

NPI: 1609081355
Provider Name (Legal Business Name): DONALD G BRONN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WALTON BLVD SUITE #211
ROCHESTER HILLS MI
48307-6917
US

IV. Provider business mailing address

PO BOX 220
BLOOMFIELD HILLS MI
48303-0220
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-7100
  • Fax: 888-885-8801
Mailing address:
  • Phone: 248-646-7100
  • Fax: 248-646-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301049436
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number050770
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME75084
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number261671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: