Provider Demographics
NPI:1699767475
Name:BRONSTEIN, BARRY D (DO)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:BRONSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27774 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2352
Mailing Address - Country:US
Mailing Address - Phone:248-356-5555
Mailing Address - Fax:248-356-5544
Practice Address - Street 1:8305 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2231
Practice Address - Country:US
Practice Address - Phone:313-894-1900
Practice Address - Fax:313-894-4206
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3142707-11Medicaid
E25544Medicare UPIN
MI3142707-11Medicaid