Healthcare Provider Details

I. General information

NPI: 1982588141
Provider Name (Legal Business Name): BRANDON MICHAEL SIKORSKI APRN, ACCNS-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE STE 4100
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-3319
  • Fax: 219-836-4678
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number71018215A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number041481018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: