Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301503787 | MI |
Y | 208600000X | Surgeon | 4301503787 | MI |
NPI | 1013367267 |
---|---|
Provider Name | Dr. Jennifer Marie Brady |
First Address | Detroit, MI 48236-2148 |
Second Address | Detroit, MI 48236-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 07/01/2021 |