=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508782947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEP MEDICAL GROUP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3045 BAKER RD STE K
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48130-1163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-215-5768
-----------------------------------------------------
Fax | 614-482-4938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2749 TRAILWOOD LN
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-210-1627
-----------------------------------------------------
Fax | 614-482-4938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARCIA BOCKBRADER
-----------------------------------------------------
Credential | MD PHD
-----------------------------------------------------
Telephone | 614-286-0305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P0301X
-----------------------------------------------------
Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083A0300X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------