MEDICARE: THOMAS WESLEY BRINK MD

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	207R00000X	Internal Medicine Physician	4301032174	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	:	1750385241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WESLEY BRINK MD

Provider Business Mailing Address
First Line	:	4444 KALAMAZOO AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-4600
Country	:	US
Telephone Number	:	616-391-5600
Fax Number	:	616-391-5685

Provider Business Practice Location Address
First Line	:	4444 KALAMAZOO AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-4600
Country	:	US
Telephone Number	:	616-391-5600
Fax Number	:	616-391-5685

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/28/2009

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Directions to “ THOMAS WESLEY BRINK MD” Practice Location

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