NPIMap

Organization Active NPI

McLaren Macomb

  • Family Medicine Physician
  • Clinton Township, MI
National Provider Identifier
1356394571
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101010690 Issued in MI
Legal business name
MCLAREN MACOMB
Practice address
36500 S Gratiot Ave
Ste. 202
Clinton Township, MI 48035
Phone
(586) 493-3727
Fax
(586) 493-3720
NPI assigned
May 18, 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
Family Medicine Physician 207Q00000X 5101010690 MI Primary

Addresses

Primary practice location

36500 S Gratiot Ave
Ste. 202
Clinton Township, MI 48035

Mailing address

36500 S Gratiot Ave
Ste. 202
Clinton Township, MI 48035-1772
Phone (586) 493-3727

Other identifiers 1

IdentifierTypeStateIssuer
4468240MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Bryan J Mazey 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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1356394571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE",
            "address_2": "STE. 202",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480351772",
            "telephone_number": "586-493-3727",
            "fax_number": "586-493-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE",
            "address_2": "STE. 202",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48035",
            "telephone_number": "586-493-3727",
            "fax_number": "586-493-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN MACOMB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4468240",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, 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.