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General NPI Number Information
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NPI Number | 1073331021
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Entity Type | Individual
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Provider Name | BRIAN CECIL PATRICK
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 616 E GILFORD RD
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City | CARO
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State | MI
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Zip | 48723
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Country | US
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Telephone | 989-430-5795
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Fax |
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Provider Business Mailing Address
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Address Line | 331 W FIKE RD
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City | SANFORD
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State | MI
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Zip | 48657-9113
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Country | US
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Telephone | 989-430-5795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | MI
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