Provider Demographics
NPI:1922528512
Name:PHALA, BRITTANY KIRSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:KIRSTIN
Last Name:PHALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4040 N EUCLID AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2493
Mailing Address - Country:US
Mailing Address - Phone:989-671-9153
Mailing Address - Fax:989-671-9253
Practice Address - Street 1:4040 N EUCLID AVE STE B
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2493
Practice Address - Country:US
Practice Address - Phone:989-671-9153
Practice Address - Fax:989-671-9253
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502581207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program