Provider Demographics
NPI:1386175800
Name:JAMES S. BROOKS, MD, PLLC
Entity type:Organization
Organization Name:JAMES S. BROOKS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-356-7772
Mailing Address - Street 1:29275 NORTHWESTERN HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29275 NORTHWESTERN HWY STE 208
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5744
Practice Address - Country:US
Practice Address - Phone:248-356-7772
Practice Address - Fax:248-356-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301403985207Y00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689653305OtherBEAUMONT HEALTH
MIP72380OtherBLUE CARE NETWORK
MI2833926Medicaid
MI0634232OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI6311410OtherCIGNA
0634232Medicare PIN
MI0634232OtherBLUE CROSS BLUE SHIELD OF MICHIGAN