Provider Demographics
NPI:1689707333
Name:BROOKS, ERIC CARY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CARY
Last Name:BROOKS
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 1:7302 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2821
Mailing Address - Country:US
Mailing Address - Phone:313-510-7700
Mailing Address - Fax:248-661-9188
Practice Address - Street 1:7302 BALSAM CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2821
Practice Address - Country:US
Practice Address - Phone:313-510-7700
Practice Address - Fax:248-661-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43001068692207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81957Medicare UPIN