Provider Demographics
NPI:1598731473
Name:BROOKS, JOHN V (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15474 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4893
Mailing Address - Country:US
Mailing Address - Phone:734-335-6103
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:1231 PINE GROVE AVE
Practice Address - Street 2:INFECTIOUS DISEASE, SUITE 1B
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-966-1993
Practice Address - Fax:810-966-1997
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-01-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301056328207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598731473Medicaid
G10731Medicare UPIN