Mary Beth Brady, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Commerce Township, MI
NPI 1831745256 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1831745256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 4301056919 (MI)
- Practice address
- 8316 Lake Pine Dr
Commerce Township, MI 48382-4529 - Phone
- (248) 363-5188
- Fax
- (248) 360-3942
- NPI assigned
- Aug 12, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301056919 | MI | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 4301056919 | MI | Yes |
Addresses
Primary practice location
8316 Lake Pine Dr
Commerce Township, MI 48382-4529
Mailing address
8316 Lake Pine Dr
Commerce Township, MI 48382-4529
Phone (248) 363-5188
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4301056919 | Other | MI | MEDICAL LICENSE |
| 1606355372 | Other | MI | BLUE CROSS |
| 4301056919 | Other | MI | CONTROLLED SUBSTANCE LICENSE |
| F59302 | Other | UPIN | |
| 2954064 | Medicaid | MI |
Other providers in Commerce Township, MI
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- Debra E Bourdeau
- Elizabeth Rose Bowlin
- Valerie Nicole Boyer
- Casey Branach
- Roland Brandt
- Janet Lynn Breeding
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- Shirley Ann Brogan
All providers in Commerce Township, MI · Obstetrics & Gynecology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.