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Individual

CRISTA BROUTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 464-0887
(734) 402-0254
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 464-0887
(734) 402-0254

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101015704
MI
208M00000X
Hospitalist Physician
5101015704
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1265537625
NPI #
MI
05
4955211-11
MI
01
70-0-F32947-0
BCBS CPIN #
MI
01
CB015704
BCBS
MI
Enumeration date
09/13/2006
Last updated
04/14/2017
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