1598731473 NPI number — JOHN V BROOKS M.D.

Table of content: JOHN V BROOKS M.D. (NPI 1598731473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598731473 NPI number — JOHN V BROOKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
JOHN
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598731473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15474 N HAGGERTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-4893
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-335-6103
Provider Business Mailing Address Fax Number:
630-734-4715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1231 PINE GROVE AVE
Provider Second Line Business Practice Location Address:
INFECTIOUS DISEASE, SUITE 1B
Provider Business Practice Location Address City Name:
PORT HURON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48060-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-966-1993
Provider Business Practice Location Address Fax Number:
810-966-1997
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  4301056328 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1598731473 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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