Provider Demographics
NPI:1407033848
Name:BROOKSIDE HEALTH CENTER PC
Entity Type:Organization
Organization Name:BROOKSIDE HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAFFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-581-2600
Mailing Address - Street 1:8790 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2491
Mailing Address - Country:US
Mailing Address - Phone:313-295-2520
Mailing Address - Fax:313-295-7310
Practice Address - Street 1:8790 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2491
Practice Address - Country:US
Practice Address - Phone:313-295-2520
Practice Address - Fax:313-295-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H20218OtherBCBSM