Provider Demographics
NPI:1942851092
Name:SLOOP, BRENT MICHAEL
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:MICHAEL
Last Name:SLOOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6691 BOCA VISTA DR NE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9654
Mailing Address - Country:US
Mailing Address - Phone:616-874-2016
Mailing Address - Fax:
Practice Address - Street 1:6691 BOCA VISTA DR NE UNIT 301
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9654
Practice Address - Country:US
Practice Address - Phone:616-874-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty