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General NPI Number Information
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NPI Number | 1114199841
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Entity Type | Organization
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Legal Business Name | LISA ANNE BRAWLEY PC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 16991 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48154-2946
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Country | US
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Telephone | 734-425-9551
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Fax | 734-425-9557
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Provider Business Mailing Address
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Address Line | 16991 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48154-2946
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Country | US
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Telephone | 734-425-9551
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Fax | 734-425-9557
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA ANNE BRAWLEY
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Credential | M.D.
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Telephone | 734-425-9551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301057908
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License Number State | MI
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