Organization
MCLAREN MACOMB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS M BRISSE (CEO)
(586) 493-8083
Entity
Organization
Contact information
Practice address
36500 S GRATIOT AVE, SUITE 102, CLINTON TOWNSHIP, MI 48035
(586) 790-9003
(586) 493-3603
Mailing address
401 S BALLENGER HWY, FLINT, MI 48532-3638
(810) 342-1000
(810) 342-1590
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110E062060
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/30/2007
Last updated
05/23/2018
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