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General NPI Number Information
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NPI Number | 1003415514
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Entity Type | Individual
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Provider Name | BRANDON M HUDSON
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 185 N FRANKLIN ST FL 3
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City | CHICAGO
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State | IL
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Zip | 60606-1932
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Country | US
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Telephone | 608-790-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 314 PARK LANE CIR
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City | ELDRIDGE
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State | IA
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Zip | 52748-9675
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Country | US
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Telephone | 563-542-3669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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