MEDICARE: SHELBY BREWINGTON PA-C

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
1	363A00000X	Physician Assistant		MI

General Provider Information

NPI Number	:	1104381847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY BREWINGTON PA-C

Provider Business Mailing Address
First Line	:	21395 WAVERLY DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1863
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MAPLE RD STE 101
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3118
Country	:	US
Telephone Number	:	248-885-8211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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Directions to “ SHELBY BREWINGTON PA-C” Practice Location

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