Provider Demographics
NPI:1003146432
Name:MICHAEL BRINES PHD MD LLC
Entity Type:Organization
Organization Name:MICHAEL BRINES PHD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-623-4427
Mailing Address - Street 1:1 WEPAWAUG RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2422
Mailing Address - Country:US
Mailing Address - Phone:203-289-2523
Mailing Address - Fax:
Practice Address - Street 1:2488 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1368
Practice Address - Country:US
Practice Address - Phone:203-204-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027562207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty