Provider Demographics
NPI:1487812665
Name:BRUMMER, AMY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:BRUMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:COSNOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4575 RAVINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1643
Mailing Address - Country:US
Mailing Address - Phone:248-310-3847
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:DEPT OF PEDIATRIC ANESTHESIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5535
Practice Address - Fax:313-745-5448
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0031942207L00000X
MI4301101596207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP1-0031942OtherPHYSICIAN IN TRAINING PERMIT