Healthcare Provider Details

I. General information

NPI: 1720346620
Provider Name (Legal Business Name): BRANDON J HOOKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 FLEETWOOD DR
PORTAGE MI
49024-5508
US

IV. Provider business mailing address

3786 FLEETWOOD DR
PORTAGE MI
49024-5508
US

V. Phone/Fax

Practice location:
  • Phone: 248-765-9369
  • Fax:
Mailing address:
  • Phone: 248-765-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101019715
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number02008606A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5101019715
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number13150
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13150-321
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5101019715
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number02008606A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: