Organization
BRUCE A. CASSIDY, D.O., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE MCGEE (OFFICE MANAGER)
(248) 308-2604
Entity
Organization
Contact information
Practice address
28080 GRAND RIVER AVE STE 208N, FARMINGTON HILLS, MI 48336-5966
(248) 308-2604
(248) 308-2608
Mailing address
PO BOX 673102, DETROIT, MI 48267-3102
(248) 308-2604
(248) 308-2608
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BC013348
MI
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114334390
—
MI
01
—
1156307745
BCBS
MI
01
—
1770568198
INDIVIDUAL NPI
MI
01
—
BC013348
MI STATE LICENSE
MI
Enumeration date
10/11/2006
Last updated
09/19/2022
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