Healthcare Provider Details

I. General information

NPI: 1952939373
Provider Name (Legal Business Name): BRANDON FREE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

IV. Provider business mailing address

303 E NICOLLET BLVD STE 330
BURNSVILLE MN
55337-4594
US

V. Phone/Fax

Practice location:
  • Phone: 952-209-9273
  • Fax:
Mailing address:
  • Phone: 952-209-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number82403
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: