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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942278320 NPPES
Michigan MEDICAID 4609491 10
Michigan Other 200953465

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