Healthcare Provider Details

I. General information

NPI: 1174843593
Provider Name (Legal Business Name): BRANT MCCARTAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N MAYFAIR RD STE 304
MILWAUKEE WI
53226-3255
US

IV. Provider business mailing address

1233 N MAYFAIR RD STE 304
MILWAUKEE WI
53226-3255
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-3322
  • Fax: 414-257-3364
Mailing address:
  • Phone: 414-257-3322
  • Fax: 414-257-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1020-25
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1020-25
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: