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, STE. 202, CLINTON TOWNSHIP, MI 48035
(586) 493-3727
(586) 493-3720
Mailing address
36500 S GRATIOT AVE, STE. 202, CLINTON TOWNSHIP, MI 48035-1772
(586) 493-3727
(586) 493-3720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101010690
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4468240
—
MI
Enumeration date
05/18/2006
Last updated
05/23/2018
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