McLaren Macomb

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MCLAREN MACOMB

Practice address

36500 S Gratiot Ave
Suite 102
Clinton Township, MI 48035

Phone

(586) 790-9003

Fax

(586) 493-3603

NPI assigned

Mar 30, 2007

Organization subpart

No

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

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1215057609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE",
            "address_2": "SUITE 102",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48035",
            "telephone_number": "586-790-9003",
            "fax_number": "586-493-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MACOMB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "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": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "110E062060",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy L McKenzie, MD
• Brandon R McKenzie, DC
• Krysti McKenzie, OTR
• Kay McKnight
• McLaren Macomb
• McLaren Macomb
• McLaren Macomb
• McLaren Macomb
• McLaren Macomb
• McLaren Macomb

• Internal Medicine Physician in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Internal Medicine Physician in Michigan

• 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.