Healthcare Provider Details

I. General information

NPI: 1437182557
Provider Name (Legal Business Name): BROOKSIDE HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/16/2008
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: 313-581-0228
Mailing address:
  • Phone: 313-295-2520
  • Fax: 313-581-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK B SAFFER
Title or Position: CEO
Credential: DPM
Phone: 313-291-2520