Provider Demographics
NPI:1114199841
Name:LISA ANNE BRAWLEY PC
Entity Type:Organization
Organization Name:LISA ANNE BRAWLEY PC
Other - Org Name:LIVONIA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-425-9551
Mailing Address - Street 1:16991 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2946
Mailing Address - Country:US
Mailing Address - Phone:734-425-9551
Mailing Address - Fax:734-425-9557
Practice Address - Street 1:16991 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2946
Practice Address - Country:US
Practice Address - Phone:734-425-9551
Practice Address - Fax:734-425-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11-0-82-3654-2OtherBLUE CROSS
MI104737070Medicaid
MI0P19080Medicare PIN