MEDICARE: BRADY THOMAS VIBERT M.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
1	207X00000X	Orthopaedic Surgery Physician	4301075858	MI
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	4301075858	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205870441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADY THOMAS VIBERT M.D.

Provider Business Mailing Address
First Line	:	1555 SOUTH BLVD E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5605
Country	:	US
Telephone Number	:	248-215-8095
Fax Number	:	248-289-1086

Provider Business Practice Location Address
First Line	:	1555 SOUTH BLVD E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5605
Country	:	US
Telephone Number	:	248-215-8095
Fax Number	:	248-289-1086

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	12/29/2020

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