MEDICARE: SUMPTER COMMUNITY CLINIC

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	207Q00000X	Family Medicine Physician	5101005511	MI

General Provider Information

NPI Number	:	1992866792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMPTER COMMUNITY CLINIC

Provider Business Mailing Address
First Line	:	19421 SUMPTER RD
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-8725
Country	:	US
Telephone Number	:	734-699-2950
Fax Number	:	734-699-6658

Provider Business Practice Location Address
First Line	:	19421 SUMPTER RD
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-8725
Country	:	US
Telephone Number	:	734-699-2950
Fax Number	:	734-699-6658

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT DAVID BROOKS
Credential	:	DO
Telephone Number	:	734-699-2950

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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Directions to “SUMPTER COMMUNITY CLINIC ” Practice Location

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