Healthcare Provider Details

I. General information

NPI: 1780172288
Provider Name (Legal Business Name): BRANDON TODD PERKOVICH MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD SAN FRANCISCO RD
SUNNYVALE CA
94086-6386
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 408-730-2860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number163516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: