Provider Demographics
NPI:1437182557
Name:BROOKSIDE HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:BROOKSIDE HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-291-2520
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:313-581-0228
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:313-581-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26079OtherBCBSM
MI4192187Medicaid
MI4456777Medicaid
MI4182654Medicaid
MI4591234Medicaid
MI3078099Medicaid
MI3078099Medicaid