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General NPI Number Information
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NPI Number | 1164510574
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Entity Type | Organization
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Legal Business Name | BROOKS LYON & BROOKS DO PC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 309 ECORSE RD
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City | YPSILANTI
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State | MI
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Zip | 48198-5733
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Country | US
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Telephone | 734-484-0580
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Fax | 734-484-6410
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Provider Business Mailing Address
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Address Line | 309 ECORSE RD
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City | YPSILANTI
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State | MI
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Zip | 48198-5733
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Country | US
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Telephone | 734-484-0580
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Fax | 734-484-6410
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CANDY L EBELER
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Credential |
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Telephone | 734-484-0580
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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 | 5101005511
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License Number State | MI
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