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General NPI Number Information
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NPI Number | 1649278748
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Entity Type | Organization
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Legal Business Name | BRIGHTON FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 401 E GRAND RIVER AVE SUITE 100
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City | BRIGHTON
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State | MI
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Zip | 48116-1562
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Country | US
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Telephone | 810-225-7773
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Fax | 810-225-7774
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Provider Business Mailing Address
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Address Line | 401 E GRAND RIVER AVE SUITE 100
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City | BRIGHTON
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State | MI
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Zip | 48116-1562
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Country | US
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Telephone | 810-225-7773
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Fax | 810-225-7774
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARY RUPP
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Credential | MD
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Telephone | 810-225-7773
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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 | 4301063298
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License Number State | MI
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