Provider Demographics
NPI:1194156083
Name:AM BROOKS JR MD & ASSOCIATES PC
Entity type:Organization
Organization Name:AM BROOKS JR MD & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDRICH
Authorized Official - Middle Name:MELTON
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:313-377-3997
Mailing Address - Street 1:17376 WESTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7628
Mailing Address - Country:US
Mailing Address - Phone:313-377-3997
Mailing Address - Fax:248-569-0186
Practice Address - Street 1:17376 WESTLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7628
Practice Address - Country:US
Practice Address - Phone:313-377-3997
Practice Address - Fax:248-569-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB027332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1630999Medicare PIN
MIA76985Medicare UPIN