Healthcare Provider Details

I. General information

NPI: 1154766046
Provider Name (Legal Business Name): BRANDON GENE CLAXTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD ANESTHESIA DEPARTMENT
DEARBORN MI
48124
US

IV. Provider business mailing address

2006 HOGBACK RD STE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7000
  • Fax:
Mailing address:
  • Phone: 734-786-4989
  • Fax: 734-786-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301111697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: