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General NPI Number Information
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NPI Number | 1205091915
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Entity Type | Individual
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Provider Name | JUSTIN LEE BRIGHT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-1557
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W 5TH ST APT 602
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City | ROYAL OAK
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State | MI
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Zip | 48067-2561
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Country | US
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Telephone | 248-462-2023
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301096746
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License Number State | MI
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