Provider Demographics
NPI:1790771145
Name:FEYZ, BRUCE B (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:B
Last Name:FEYZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7505 GRAFTON RD
Mailing Address - Street 2:STE 4
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-8908
Mailing Address - Country:US
Mailing Address - Phone:734-586-6311
Mailing Address - Fax:734-586-6318
Practice Address - Street 1:7505 GRAFTON RD
Practice Address - Street 2:STE 4
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-8908
Practice Address - Country:US
Practice Address - Phone:734-586-6311
Practice Address - Fax:734-586-6318
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBF036463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
050001OtherBC
MI2100471Medicaid
060000225OtherMEDICARE RAILROAD
050001OtherBC
B46950Medicare UPIN