Provider Demographics
NPI:1134295504
Name:LITTLE, BRYAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:E
Last Name:LITTLE
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:PO BOX 673671
Mailing Address - Street 2:DMC BILLING ASSOCIATES, LLC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-3671
Mailing Address - Country:US
Mailing Address - Phone:313-745-4230
Mailing Address - Fax:313-745-4298
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4230
Practice Address - Fax:313-745-4298
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083398207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL083398OtherCOMMERCIAL-COMMERCIAL NUMBER
MI464325010Medicaid
700H262250OtherBLUE CROSS-BLUE CROSS
BL083398OtherCHAMPUS-CHAMPUS
MI464325010Medicaid
MIP35120149Medicare PIN
I17160Medicare UPIN