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General NPI Number Information
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NPI Number | 1982750881
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Entity Type | Individual
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Provider Name | EVERETT BRYANT MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 4241 MAPLE ST SUITE 200D
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City | DEARBORN
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State | MI
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Zip | 48126-3826
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Country | US
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Telephone | 313-584-1940
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Fax | 313-584-1945
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Provider Business Mailing Address
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Address Line | 4241 MAPLE ST SUITE 200D
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City | DEARBORN
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State | MI
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Zip | 48126-3826
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Country | US
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Telephone | 313-584-1940
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Fax | 313-584-1945
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | EB060301
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License Number State | MI
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