=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447745658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE BRINKMANN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2018
-----------------------------------------------------
Last Update Date | 06/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 570 KIRTS BLVD STE 231
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48084-4156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-269-1345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3121 BLOOMCREST DR
-----------------------------------------------------
City | SHELBY TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-484-5133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6802077227
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------