Organization
MCLAREN MACOMB
Active
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
Update your record
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