BRENT FUNK (NPI# 1053659482) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053659482 |
| Entity Type | Individual |
| Full Name | BRENT FUNK |
| Credential | PSY.D. |
| Practice Address |
1 Ford Pl 1e Detroit MI 48202-3450 |
| Practice Telephone | 3138746651 |
| Mailing Telephone | 3138746651 |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2013-01-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 6301014872 | MI | Behavioral Health & Social Service Providers |
| Street Address |
1 FORD PL 1E |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-3450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447241229 | Mary Hicks | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202 | 2005-11-02 |
| 1548870769 | Robert Devore | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2020-08-03 |
| 1740831668 | Sarah Anna Moore | Social Worker | 1 Ford Pl, Detroit, MI 48202-3450 | 2019-09-23 |
| 1043863897 | Bethany Thayer | Dietitian, Registered | 1 Ford Pl, Detroit, MI 48202-3450 | 2019-07-22 |
| 1609380328 | Tanesha Lowery | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-11-17 |
| 1972012904 | Alaina Grace Esposito | Social Worker | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-09-21 |
| 1780107029 | Kellie Martens | Psychologist | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-07-19 |
| 1164956538 | Shaelyn Nicole Gurzick | Dietitian, Registered | 1 Ford Pl, Suite 5c, Detroit, MI 48202-3450 | 2017-04-12 |
| 1093251878 | Chinwe Obioha | Nurse Practitioner | 1 Ford Pl, Detroit, MI 48202-3450 | 2017-01-17 |
| 1881142115 | Ivory Villanueva Fulgencio | Nurse Anesthetist, Certified Registered | 1 Ford Pl, Ste 2e, Detroit, MI 48202-3450 | 2016-09-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588828453 | Jin Lee Kim | Clinical Neuropsychologist | 1 Ford Pl Ste 1e, Detroit, MI 48202-3450 | 2008-07-10 |
| 1841340312 | Raymond Mckinley Campbell IIi | Clinical Neuropsychologist | 1511 1st St, Suite 1308, Detroit, MI 48226-1351 | 2007-01-10 |
| 1104939107 | Jannel M Phillips | Clinical Neuropsychologist | 1 Ford Place, Detroit, MI 48202 | 2006-08-16 |
| 1952330474 | Univeristy Affiliated Neurologists | Clinical Neuropsychologist | 4201 St. Antoine St, Suite 8d, Detroit, MI 48201 | 2006-06-30 |
| 1457390254 | University Physician Group | Clinical Neuropsychologist | 4201 Saint Antoine St., Suite 8d, Detroit, MI 48201 | 2006-06-06 |
| 1225038904 | Scott Richard Millis | Clinical Neuropsychologist | 261 Mack Ave, Rehabilitation Institute of Michigan, Rm 552, Detroit, MI 48201-2417 | 2005-07-26 |
| 1285116384 | Allison Josephine Lake | Clinical Neuropsychologist | 261 Mack Ave Ste 555, Detroit, MI 48201-2417 | 2018-09-05 |
| 1487193207 | Vilija Petrauskas | Clinical Neuropsychologist | 1 Ford Pl Ste 1e, Detroit, MI 48202-3450 | 2017-02-13 |
| 1215295191 | Kathleen Margaret Hagelthorn | Clinical Neuropsychologist | 1 Ford Pl Ste 2e, Detroit, MI 48202-3450 | 2012-04-27 |
| 1063741270 | Adult Neuropsychology | Clinical Neuropsychologist | 4201 Saint Antoine St, 4j Uhc, Detroit, MI 48201-2153 | 2009-12-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.