Provider Demographics
NPI:1285605774
Name:BRUCE TERRIO MD, PC
Entity type:Organization
Organization Name:BRUCE TERRIO MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TERRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-496-0927
Mailing Address - Street 1:PO BOX 67000 DEPT 291701
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:248-347-8191
Mailing Address - Fax:440-934-6147
Practice Address - Street 1:12675 WHALEN LAKE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-1513
Practice Address - Country:US
Practice Address - Phone:248-347-8191
Practice Address - Fax:440-934-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P37680Medicare PIN