NPIMap

Organization Active NPI

McLaren Macomb

  • Pediatrics Physician
  • Mount Clemens, MI
National Provider Identifier
1083669691
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301085002 Issued in MI
Legal business name
MCLAREN MACOMB
Practice address
1000 Harrington Blvd.
Attn: Special Care Nursery
Mt. Clemens, MI 48043
Phone
(586) 493-8296
Fax
(586) 741-4114
NPI assigned
May 23, 2006
Last updated
May 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas M Brisse
Title
Ceo
Phone
(586) 493-8083

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301085002 MI Primary

Addresses

Primary practice location

1000 Harrington Blvd.
Attn: Special Care Nursery
Mt. Clemens, MI 48043

Mailing address

1000 Harrington Blvd.
Attn: Special Care Nursery
Mt. Clemens, MI 48043-2920
Phone (586) 493-8296

Other identifiers 1

IdentifierTypeStateIssuer
4819971MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Mary Garavaglia DO12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1083669691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON BLVD.",
            "address_2": "ATTN: SPECIAL CARE NURSERY",
            "city": "MT. CLEMENS",
            "state": "MI",
            "postal_code": "480432920",
            "telephone_number": "586-493-8296",
            "fax_number": "586-741-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON BLVD.",
            "address_2": "ATTN: SPECIAL CARE NURSERY",
            "city": "MT. CLEMENS",
            "state": "MI",
            "postal_code": "48043",
            "telephone_number": "586-493-8296",
            "fax_number": "586-741-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MACOMB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "BRISSE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-493-8083",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301085002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4819971",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.