Provider Demographics
NPI:1215558945
Name:BROTHERSON, TEMMY J (MD)
Entity Type:Individual
Prefix:
First Name:TEMMY
Middle Name:J
Last Name:BROTHERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 GREENCREST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7756
Mailing Address - Country:US
Mailing Address - Phone:586-244-3172
Mailing Address - Fax:
Practice Address - Street 1:SPARROW HEALTH SYSTEMS
Practice Address - Street 2:1200 E MICHIGAN AVENUES, SUITE 245
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine