Individual
MR. BRODY A WEBSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22471 GRATIOT AVE, EASTPOINTE, MI 48021-2353
(586) 218-7774
Mailing address
16261 ROSELAWN ST, DETROIT, MI 48221-4929
(989) 277-6060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008749
MI
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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