Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301075858 | MI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301075858 | MI |
NPI | 1205870441 |
---|---|
Provider Name | Brady Thomas Vibert |
First Address | Rochester Hills, MI 48307-5605 |
Second Address | Rochester Hills, MI 48307-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4888315 | (05) | MI |
I40217 | (02) | CA |
I40217 | (02) | MI |