Healthcare Provider Details

I. General information

NPI: 1255431946
Provider Name (Legal Business Name): DAVID LEONARD BRANDRETH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6199 MILLER RD SUITE B
SWARTZ CREEK MI
48473-1585
US

IV. Provider business mailing address

6199 MILLER RD SUITE B
SWARTZ CREEK MI
48473-1585
US

V. Phone/Fax

Practice location:
  • Phone: 810-635-0554
  • Fax: 810-635-0558
Mailing address:
  • Phone: 810-635-0554
  • Fax: 810-635-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: