Provider Demographics
NPI:1942387410
Name:ENGEL, BRIAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:ENGEL
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 1:30061 SCHOENHERR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3133
Mailing Address - Country:US
Mailing Address - Phone:586-558-2111
Mailing Address - Fax:586-558-2169
Practice Address - Street 1:30061 SCHOENHERR RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3133
Practice Address - Country:US
Practice Address - Phone:586-558-2111
Practice Address - Fax:586-558-2169
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3081728Medicaid
MI3081728Medicaid