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General NPI Number Information
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NPI Number | 1891207528
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Entity Type | Individual
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Provider Name | BRANDON J BARONI AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 1025 S ORTONVILLE RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-8739
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Country | US
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Telephone | 248-627-1829
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Fax | 248-627-6913
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Provider Business Mailing Address
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Address Line | 7904 DONEGAL CT
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City | FENTON
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State | MI
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Zip | 48430-4802
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Country | US
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Telephone | 248-330-2234
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601000340
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License Number State | MI
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