Individual
DR. BRIAN VAL FAVERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1033 RIVER ST, SUITE 2, PORT HURON, MI 48060-3463
(810) 985-9600
(810) 985-9244
Mailing address
1033 RIVER ST, SUITE 2, PORT HURON, MI 48060-3463
(810) 985-9600
(810) 985-9244
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
BF064615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M34510001
MEDICARE INDIVIDUAL
MI
01
—
1807400532
BLUE CROSS OF MICHIGAN
MI
Enumeration date
03/28/2006
Last updated
05/19/2008
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