NPI 1154805083

Brody a Webster, PAC

Practitioner Physician Assistant Eastpointe, MI

Practice location

Address: 22471 Gratiot Ave, Eastpointe, MI 48021-2353
Phone: (586) 218-7774
Mailing address: 16261 Roselawn St, Detroit, MI 48221-4929

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601008749 (MI)

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Registry record

NPI: 1154805083
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 Sep 2018
Record last updated: 17 Sep 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.