Provider Demographics
NPI:1629344643
Name:NEWMAN, BRUCE HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HENRY
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:28190 TAVISTOCK TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5180
Mailing Address - Country:US
Mailing Address - Phone:313-549-7014
Mailing Address - Fax:313-833-4461
Practice Address - Street 1:100 E. MACK AVE.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-549-7014
Practice Address - Fax:313-833-4461
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061174207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine