Provider Demographics
NPI:1336262203
Name:HOWARD S. BRODE, M.D., P.C.
Entity Type:Organization
Organization Name:HOWARD S. BRODE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-333-1010
Mailing Address - Street 1:10 W SQUARE LAKE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0465
Mailing Address - Country:US
Mailing Address - Phone:248-333-1010
Mailing Address - Fax:
Practice Address - Street 1:10 W SQUARE LAKE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0465
Practice Address - Country:US
Practice Address - Phone:248-333-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0433512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI043351OtherMEDICAL LISCENCE #
MI2606303022OtherBCBS PROVIDER #
MI2606303022OtherBCBS PROVIDER #
MI2606303022OtherBCBS PROVIDER #
MIB43800Medicare UPIN
MI2606303022OtherBCBS PROVIDER #