Basic Information
| Provider Information | |||||||||
| NPI: | 1134295504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673671 | ||||||||
| Address2: | DMC BILLING ASSOCIATES, LLC | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482673671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454230 | ||||||||
| FaxNumber: | 3137454298 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454230 | ||||||||
| FaxNumber: | 3137454298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 4301083398 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | BL083398 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 464325010 | 05 | MI | MEDICAID | 700H262250 | 01 | BLUE CROSS-BLUE CROSS | OTHER | BL083398 | 01 | CHAMPUS-CHAMPUS | OTHER |