Provider Demographics
NPI:1679913594
Name:PERKINS, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:PERKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4222
Mailing Address - Country:US
Mailing Address - Phone:734-240-8430
Mailing Address - Fax:734-240-8495
Practice Address - Street 1:650 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4222
Practice Address - Country:US
Practice Address - Phone:734-240-8430
Practice Address - Fax:734-240-8495
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine