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1144883703 NPI number — BRENDA L MA DO

NPI Number: 1144883703
Health Care Provider/Practitioner: BRENDA L MA DO

Information about “1144883703” NPI (BRENDA L MA DO) exists in 1144883703 in HTML format HTML  |  1144883703 in plain Text format TXT  |  1144883703 in PDF (Portable Document Format) PDF  |  1144883703 in an XML format XML  formats.

NPI Number : 1144883703 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144883703",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MA",
    "FirstName": "BRENDA",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5400 MACKINAW RD FL 5",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAGINAW",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48604-9515",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-583-5195",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5400 MACKINAW RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAGINAW",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48604-9515",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-583-5200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/19/2019",
    "LastUpdateDate": "11/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208600000X",
        "TaxonomyName": "Surgery Physician",
        "LicenseNumber": "5101028695",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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