Individual
DR. KEVIN ALEXANDER BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15855 19 MILE ROAD, EMERGENCY MEDICINE DEPARTMENT, CLINTON TWP, MI 48038-3504
(586) 236-2601
(586) 263-2589
Mailing address
38935 ANN ARBOR ROAD, CREDENTIALING/PAYER CONTRACTING SERVICES, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101244238
VA
207P00000X
Emergency Medicine Physician
Primary
4301061861
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0108236832
BCBS PIN
—
05
—
10-4247777
—
MI
05
—
10-4247786
—
MI
05
—
10-4247795
—
MI
05
—
10-4247801
—
MI
05
—
10-4247810
—
MI
05
—
10-4247820
—
MI
05
—
10-4247839
—
MI
05
—
10-4247848
—
MI
05
—
10-4777110
—
MI
05
—
1063490621
—
MI
01
—
11272666
CAQH
—
01
—
KB061861
BCBS
—
Enumeration date
01/04/2006
Last updated
10/16/2014
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