MCLAREN MACOMB

Provider Demographics

• NPI: 1285685339
• Name: MCLAREN MACOMB
• Entity Type: Organization
• Organization Name: MCLAREN MACOMB
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: THOMAS
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: BRISSE
• Authorized Official - Phone: 586-493-8083
• Mailing Address - Street 1: 36500 S GRATIOT AVE
• Mailing Address - Street 2: STE. 102
• Mailing Address - City: CLINTON TOWNSHIP
• Mailing Address - State: MI
• Mailing Address - Zip Code: 48035-1772
• Mailing Address - Country: US
• Mailing Address - Phone: 586-790-9003
• Mailing Address - Fax: 586-493-3603
• Practice Address - Street 1: 36500 S GRATIOT AVE
• Practice Address - Street 2: STE. 102
• Practice Address - City: CLINTON TOWNSHIP
• Practice Address - State: MI
• Practice Address - Zip Code: 48035
• Practice Address - Country: US
• Practice Address - Phone: 586-790-9003
• Practice Address - Fax: 586-493-3603
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-13
• Last Update Date: 2018-05-24

Provider Licenses

State	License ID	Taxonomies
MI	5101014297	207R00000X
MI	5101013302	207RG0300X
		207X00000X, 208600000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RG0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Geriatric Medicine	Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	A76592	Medicare UPIN
MI	E26876	Medicare UPIN
MI	E41641	Medicare UPIN
MI	H37167	Medicare UPIN
MI	H61334	Medicare UPIN
MI	E93386	Medicare UPIN
MI	H91341	Medicare UPIN
MI	E22110	Medicare UPIN
MI	F04800	Medicare UPIN
MI	G97296	Medicare UPIN
MI	H68105	Medicare UPIN
MI	E26084	Medicare UPIN
MI	E26124	Medicare UPIN
MI	H95741	Medicare UPIN
MI	E26059	Medicare UPIN
MI	G71693	Medicare UPIN
MI	H44628	Medicare UPIN
MI	G19567	Medicare UPIN
MI	G75773	Medicare UPIN
MI	G80160	Medicare UPIN