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Organization

MCLAREN MACOMB

Active
Other names
Pediatric Specialty Group
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. THOMAS M BRISSE (CEO)
(586) 493-8083
Entity
Organization

Contact information

Practice address
43900 GARFIELD RD, STE. 201, CLINTON TOWNSHIP, MI 48038
(586) 412-5110
(586) 412-5116
Mailing address
43900 GARFIELD RD, STE. 201, CLINTON TOWNSHIP, MI 48038-1128
(586) 412-5110
(586) 412-5116

Taxonomy

Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
2080P0202X
Pediatric Cardiology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3298762
MI
05
3298780
MI
05
3518937
MI
05
4168314
MI
Enumeration date
05/13/2006
Last updated
05/23/2018
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