Provider Demographics
NPI:1629077763
Name:WEST, BRUCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27177 LAHSER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4714
Mailing Address - Country:US
Mailing Address - Phone:248-352-8970
Mailing Address - Fax:248-352-8933
Practice Address - Street 1:27177 LAHSER RD
Practice Address - Street 2:STE. 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4714
Practice Address - Country:US
Practice Address - Phone:248-352-8970
Practice Address - Fax:248-352-8933
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-10-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301051847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4352119-10Medicaid
MI4352119-10Medicaid
MIF23751Medicare UPIN