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General NPI Number Information
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NPI Number | 1558928010
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Entity Type | Individual
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Provider Name | BRANDON BET DO
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Gender | Male
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 2200 SPRINGPORT RD
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City | JACKSON
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State | MI
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Zip | 49202-1432
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Country | US
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Telephone | 517-205-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 5101028141
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License Number State | MI
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