Provider Demographics
NPI:1003877366
Name:STERN, BRIGITTE K (MD)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:K
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64580 VAN DYKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2857
Mailing Address - Country:US
Mailing Address - Phone:586-752-9629
Mailing Address - Fax:586-752-4099
Practice Address - Street 1:64580 VAN DYKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2857
Practice Address - Country:US
Practice Address - Phone:586-752-9629
Practice Address - Fax:586-752-4099
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4373790Medicaid
MI4373790Medicaid
MIMI3971Medicare PIN
MIN40170006Medicare ID - Type UnspecifiedMEDICARE