Healthcare Provider Details

I. General information

NPI: 1760945075
Provider Name (Legal Business Name): BRENDAN JAMES TAMM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

419 W REDWOOD ST STE 470
BALTIMORE MD
21201-7009
US

V. Phone/Fax

Practice location:
  • Phone: 248-652-5000
  • Fax:
Mailing address:
  • Phone: 166-721-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0097029
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: