Individual
DR. BRUCE ALAN CASSIDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
28080 GRAND RIVER AVE STE 208N, FARMINGTON HILLS, MI 48336-5966
(248) 308-2604
(248) 308-2608
Mailing address
28080 GRAND RIVER AVE STE 208N, FARMINGTON HILLS, MI 48336-5966
(248) 308-2604
(248) 308-2608
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101013348
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114334390
—
MI
01
—
N89000001
MEDICARE PTAN
MI
Enumeration date
12/08/2005
Last updated
09/19/2022
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