Healthcare Provider Details

I. General information

NPI: 1285336933
Provider Name (Legal Business Name): BRANDON MICHAEL FELTZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 26 MILE RD
WASHINGTON MI
48094-2804
US

IV. Provider business mailing address

299 BROOK DR
ROMEO MI
48065-5016
US

V. Phone/Fax

Practice location:
  • Phone: 586-935-4000
  • Fax:
Mailing address:
  • Phone: 248-404-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1198793
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012447
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: