Individual
DR. LACESHA BRINTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2617 W GRAND BLVD, DETROIT, MI 48208-1234
(734) 464-3400
(734) 464-4550
Mailing address
2617 W GRAND BLVD, DETROIT, MI 48208-1234
(734) 464-3400
(734) 464-4550
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301074975
MI
208600000X
Surgery Physician
Primary
LB074975
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200953465
TAX ID
MI
05
—
4609491 10
—
MI
Enumeration date
03/10/2006
Last updated
08/13/2013
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