Provider Demographics
NPI:1629274030
Name:MIDWEST HEALTH CENTER-BROOKSIDE
Entity Type:Organization
Organization Name:MIDWEST HEALTH CENTER-BROOKSIDE
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:313-586-6038
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:313-292-3900
Mailing Address - Fax:313-292-0038
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:313-292-3900
Practice Address - Fax:313-292-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty