Provider Demographics
NPI:1710018569
Name:BRIGHTON INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:BRIGHTON INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-494-6800
Mailing Address - Street 1:2305 GENOA BUSINESS PARK DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114
Mailing Address - Country:US
Mailing Address - Phone:810-494-6898
Mailing Address - Fax:810-229-4990
Practice Address - Street 1:1225 S LATSON RD STE 200
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7660
Practice Address - Country:US
Practice Address - Phone:810-494-6800
Practice Address - Fax:517-338-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N96790Medicare ID - Type Unspecified