Provider Demographics
NPI:1285840132
Name:GEDDIE, BROOKE ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ELIZABETH
Last Name:GEDDIE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-267-2605
Mailing Address - Fax:616-267-2606
Practice Address - Street 1:35 MICHIGAN ST NE
Practice Address - Street 2:SUITE 5101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2514
Practice Address - Country:US
Practice Address - Phone:616-267-2605
Practice Address - Fax:616-267-2606
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116021096207W00000X
MDH0068940207W00000X
DCDO034275207W00000X
MI5101016399207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285840132Medicaid