Provider Demographics
NPI:1669451621
Name:MCINTOSH, BRUCE B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:B
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 270
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-853-3100
Mailing Address - Fax:248-853-4300
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 270
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-853-3100
Practice Address - Fax:248-853-4300
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054159208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3056500Medicaid
F78393Medicare UPIN
06349948021Medicare ID - Type Unspecified