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
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043
(586) 493-8747
Mailing address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043-2920
(586) 493-8747
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
368295300
USDOL
MI
01
—
430E061500
BCBS
MI
01
—
OP821297
MCARE
MI
Enumeration date
06/16/2006
Last updated
05/23/2018
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