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General NPI Number Information
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NPI Number | 1841687068
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Entity Type | Individual
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Provider Name | BRANDON TRIVAX D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2015
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 3535 W 13 MILE RD STE 437
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City | ROYAL OAK
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State | MI
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Zip | 48073-6770
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Country | US
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Telephone | 248-288-2210
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Fax | 248-589-9875
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Provider Business Mailing Address
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Address Line | 2500 METROHEALTH DR
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City | CLEVELAND
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State | OH
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Zip | 44109-1900
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Country | US
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Telephone |
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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 | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 58.030743
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License Number State | OH
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