1275631350 NPI number — DR. SARAH D BRANDT MD

Table of content: DR. SARAH D BRANDT MD (NPI 1275631350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275631350 NPI number — DR. SARAH D BRANDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDT
Provider First Name:
SARAH
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUGH
Provider Other First Name:
SARAH
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275631350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3955 PARKLAWN AVE
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-5655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-831-1944
Provider Business Mailing Address Fax Number:
952-278-6947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3955 PARKLAWN AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-5655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-831-1944
Provider Business Practice Location Address Fax Number:
952-278-6947
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  40110 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FP9021019362 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1201484 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 17G86PU . This is a "BC/BS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".