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NPI Code Detail

MEDICARE: DR. THOMAS GERALD BREWER PH.D.

MEDICARE: DR. THOMAS GERALD BREWER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist6301009090MI
2103TC2200XClinical Child & Adolescent Psychologist6301009090MI
3103TF0200XForensic Psychologist6301009090MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1680H1480600OTHERMIBLUE CROSS BLUE SHIELD NO

General Provider Information

NPI Number : 1033323563
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS GERALD BREWER PH.D.
Provider Business Mailing Address
First Line : 3200 W. LIBERTY RD.
Second Line : SUITE A
City : ANN ARBOR
State : MI
Zip : 48103-9794
Country : US
Telephone Number : 734-994-9181
Fax Number :
Provider Business Practice Location Address
First Line : 3200 W. LIBERTY RD.
Second Line : SUITE A
City : ANN ARBOR
State : MI
Zip : 48103-9794
Country : US
Telephone Number : 734-994-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/25/2012

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