Provider Demographics
NPI:1821234998
Name:PROUD MARY BRAS
Entity Type:Organization
Organization Name:PROUD MARY BRAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIC BUSINESS UNIT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-264-2283
Mailing Address - Street 1:6305 WALL ST
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1078
Mailing Address - Country:US
Mailing Address - Phone:877-627-9272
Mailing Address - Fax:
Practice Address - Street 1:6305 WALL ST
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1078
Practice Address - Country:US
Practice Address - Phone:877-627-9272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALPIN DESIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier