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NPI Code Detail

MEDICARE: TODD D BRANDON M.D.

MEDICARE: TODD D BRANDON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician01053917AIN

General Provider Information

NPI Number : 1174594766
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD D BRANDON M.D.
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 306 E MAUMEE ST STE 102
Second Line :
City : ANGOLA
State : IN
Zip : 46703-2044
Country : US
Telephone Number : 260-668-8633
Fax Number : 260-668-7563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 10/17/2022

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Directions to “ TODD D BRANDON M.D.” Practice Location

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