Provider Demographics
NPI:1538234547
Name:SCOTT BRASSEUR MD PLC
Entity type:Organization
Organization Name:SCOTT BRASSEUR MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:BRASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-945-2419
Mailing Address - Street 1:1005 W GREEN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1712
Mailing Address - Country:US
Mailing Address - Phone:269-945-2419
Mailing Address - Fax:269-945-0357
Practice Address - Street 1:1005 W GREEN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1712
Practice Address - Country:US
Practice Address - Phone:269-945-2419
Practice Address - Fax:269-945-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI051816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4956827Medicaid
MIDF5489OtherPALMETTO GBA RAILROAD
MIE80216Medicare UPIN
MI0P39600Medicare PIN