Provider Demographics
NPI:1043241573
Name:DE BEAUBIEN, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:DE BEAUBIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 GENOA BUSINESS PARK DR
Mailing Address - Street 2:STE 170
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7005
Mailing Address - Country:US
Mailing Address - Phone:810-299-8550
Mailing Address - Fax:810-844-0837
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-7450
Practice Address - Fax:989-583-7452
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBD054539207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4386654Medicaid
MION47170Medicare ID - Type Unspecified
MIF79553Medicare UPIN