1740271162 NPI number — ROLAND BRANDT DO

Table of content: ROLAND BRANDT DO (NPI 1740271162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740271162 NPI number — ROLAND BRANDT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDT
Provider First Name:
ROLAND
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740271162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WILLIAM CARLS DR
Provider Second Line Business Mailing Address:
RSC
Provider Business Mailing Address City Name:
COMMERCE TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-937-4947
Provider Business Mailing Address Fax Number:
248-937-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WILLIAM CARLS DR
Provider Second Line Business Practice Location Address:
RSC
Provider Business Practice Location Address City Name:
COMMERCE TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-937-4947
Provider Business Practice Location Address Fax Number:
248-937-5150
Provider Enumeration Date:
11/03/2005

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: 207X00000X , with the licence number:  5101007240 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4127008 TYPE 11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4127017 TYPE 11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5606110001 . This is a "ADMINISTAR FED DME RSC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C5548 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5606110003 . This is a "ADMINISTAR FED DME HARTLAND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4518251 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2056305914 . This is a "BCBSM PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 502919 . This is a "CARE CHCS/PREF CHCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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