Healthcare Provider Details

I. General information

NPI: 1407033848
Provider Name (Legal Business Name): BROOKSIDE HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 TELEGRAPH RD
TAYLOR MI
48180-2491
US

IV. Provider business mailing address

8790 TELEGRAPH RD
TAYLOR MI
48180-2491
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-2520
  • Fax: 313-295-7310
Mailing address:
  • Phone: 313-295-2520
  • Fax: 313-295-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAFFER B SAFFER
Title or Position: CEO
Credential:
Phone: 313-581-2600