Brintley, Lacesha
Brintley, Lacesha is an sole proprietor health care provider with primary practice located at 2617 W Grand Blvd , Detroit MI 48208-1234. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is her primary health care specialty. Brintley, Lacesha can be contacted via phone (734) 464-3400.Contact Information
Primary practice address
2617 W Grand Blvd
Detroit MI 48208-1234
Phone: (734) 464-3400
Fax: (734) 464-4550
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Other Service Providers / Specialist | 174400000X | 4301074975 | Michigan |
Allopathic & Osteopathic Physicians / Surgery | 208600000X | LB074975 | Michigan |
Profile Details
NPI number | 1942278320 |
---|---|
LBN Legal business name | Brintley, Lacesha |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Mar 10th, 2006 |
Last updated | Aug 13th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1942278320 | NPPES |
Michigan | MEDICAID | 4609491 10 | |
Michigan | Other | 200953465 |
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