Provider Demographics
NPI:1952507758
Name:REUSSER, BRENT (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:REUSSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40450 TAMARACK DR
Mailing Address - Street 2:APT 203
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13355 EAST TEN MILE ROAD
Practice Address - Street 2:ATTN MEDICAL EDUCATION
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-759-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010159942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology