Basic Information
| Provider Information | |||||||||
| NPI: | 1043241573 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DE BEAUBIEN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 GENOA BUSINESS PARK DR | ||||||||
| Address2: | STE 170 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102998550 | ||||||||
| FaxNumber: | 8108440837 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 COOPER AVE | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895837450 | ||||||||
| FaxNumber: | 9895837452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | BD054539 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4386654 | 05 | MI | MEDICAID |