Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MB081339 | MI |
NPI | 1164497194 |
---|---|
Provider Name | Dr. Michael Andrew Brager |
First Address | Livonia, MI 48154-5083 |
Second Address | Livonia, MI 48154-5083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200H219010 | BCBS (01) | MI |
4566680 | (05) | MI |
G88747 | (02) | MI |