Healthcare Provider Details

I. General information

NPI: 1285613364
Provider Name (Legal Business Name): WARREN L BRANDES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD STE 201
MADISON HEIGHTS MI
48071-5711
US

IV. Provider business mailing address

29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS MI
48334-3292
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-0100
  • Fax: 248-399-3960
Mailing address:
  • Phone: 248-851-1430
  • Fax: 248-851-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101006748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: