Provider Demographics
NPI:1508361916
Name:STANDIFER-BARRETT, BRYANNE NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:BRYANNE
Middle Name:NICOLE
Last Name:STANDIFER-BARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6210
Mailing Address - Country:US
Mailing Address - Phone:248-849-7400
Mailing Address - Fax:248-849-7401
Practice Address - Street 1:22250 PROVIDENCE DR STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6210
Practice Address - Country:US
Practice Address - Phone:248-849-7400
Practice Address - Fax:248-849-7401
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301504235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program