Individual
MARY BETH BRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8316 LAKE PINE DR, COMMERCE TOWNSHIP, MI 48382-4529
(248) 363-5188
(248) 360-3942
Mailing address
8316 LAKE PINE DR, COMMERCE TOWNSHIP, MI 48382-4529
(248) 363-5188
(248) 360-3942
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301056919
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1606355372
BLUE CROSS
MI
05
—
2954064
—
MI
01
—
4301056919
MEDICAL LICENSE
MI
01
—
F59302
UPIN
—
Enumeration date
08/12/2019
Last updated
03/07/2023
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