Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301403985 | MI |
NPI | 1689665291 |
---|---|
Provider Name | Dr. James S Brooks |
First Address | Southfield, MI 48034-5744 |
Second Address | Southfield, MI 48034-5744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 13/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2833926 | (05) | MI |
E30067 | (02) |