Provider Demographics
NPI:1285829341
Name:BRADY, DARRELL LYNN
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 E LAKE LANSING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2288
Mailing Address - Country:US
Mailing Address - Phone:517-333-0968
Mailing Address - Fax:517-333-4306
Practice Address - Street 1:3496 E LAKE LANSING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2288
Practice Address - Country:US
Practice Address - Phone:517-333-0968
Practice Address - Fax:517-333-4306
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB0563874OtherDEA