Provider Demographics
NPI:1457771057
Name:MAXWELL, BRIANNE MARCHAND (DO)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:MARCHAND
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:DEPT. H-90
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-3231
Mailing Address - Fax:248-858-6279
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:DEPT. H-90
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3231
Practice Address - Fax:248-858-6279
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0060583207V00000X
MI5101021034207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology