Individual
DR. BROOKE M BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2333 BIDDLE AVE, WYANDOTTE, MI 48192-4668
(734) 246-6000
Mailing address
1 FORD PL STE 2E, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301502392
MI
208600000X
Surgery Physician
D0066466
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413562800
—
MD
01
—
607156013
DEPT OF LABOR
—
01
—
91645102
CAREFIRST MARYLAND
—
01
—
V7930013
CAREFIRST DC
—
Enumeration date
08/18/2007
Last updated
03/08/2021
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