Provider Demographics
NPI:1346551074
Name:COMPREHENSIVE BREAST CARE PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE BREAST CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-687-7300
Mailing Address - Street 1:44199 DEQUINDRE RD
Mailing Address - Street 2:SUITE 609
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1128
Mailing Address - Country:US
Mailing Address - Phone:248-687-7300
Mailing Address - Fax:248-687-7305
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE 609
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-687-7300
Practice Address - Fax:248-687-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0635776OtherBCBSMI
MI1346551074Medicaid
0635776OtherBCBSMI