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General NPI Number Information
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NPI Number | 1194866004
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Entity Type | Individual
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Provider Name | MR. MICHAEL N BRODOSKI
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 37650 PROFESSIONAL CTR DR STE 125 A
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City | LIVONIA
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State | MI
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Zip | 48154
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Country | US
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Telephone | 734-953-0233
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Fax | 734-462-1496
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Provider Business Mailing Address
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Address Line | 37650 PROFESSIONAL CTR DR STE 125 A
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City | LIVONIA
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State | MI
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Zip | 48154
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Country | US
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Telephone | 734-953-0233
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Fax | 734-462-1496
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State | MI
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