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General NPI Number Information
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NPI Number | 1649490558
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Entity Type | Organization
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Legal Business Name | BRIGHTMOOR MEDICAL CENTER
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 20510 FENKELL ROAD
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City | DETROIT
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State | MI
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Zip | 48223-1613
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Country | US
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Telephone | 313-534-6611
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Fax | 313-534-2525
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Provider Business Mailing Address
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Address Line | 20510 FENKELL ST PO BOX 23035
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City | DETROIT
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State | MI
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Zip | 48223-1613
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Country | US
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Telephone | 313-534-6611
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Fax | 313-534-2525
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Authorized Official
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Title or Position | DIRECTOR OF DEVELOPMENT
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Name | MR. ALEX PICKENS III
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Credential |
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Telephone | 313-534-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number | 4301038348
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License Number State | MI
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