Healthcare Provider Details

I. General information

NPI: 1508979667
Provider Name (Legal Business Name): MERRILEE R BRANDT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E STATE ST
EAST TAWAS MI
48730-1328
US

IV. Provider business mailing address

110 E STATE ST
EAST TAWAS MI
48730-1328
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-1273
  • Fax: 989-362-2343
Mailing address:
  • Phone: 989-362-1273
  • Fax: 989-362-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301 MB064187
License Number StateMI

VIII. Authorized Official

Name: PATTI ANDERSEN
Title or Position: BILLING MANAGER
Credential:
Phone: 989-362-1273