MEDICARE: DR. DAVID LEONARD BRANDRETH D.P.M.

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
1	213E00000X	Podiatrist	5901001472	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5251018	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1255431946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEONARD BRANDRETH D.P.M.

Provider Business Mailing Address
First Line	:	6199 MILLER RD
Second Line	:	SUITE B
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1585
Country	:	US
Telephone Number	:	810-635-0554
Fax Number	:	810-635-0558

Provider Business Practice Location Address
First Line	:	6199 MILLER RD
Second Line	:	SUITE B
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1585
Country	:	US
Telephone Number	:	810-635-0554
Fax Number	:	810-635-0558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/14/2010

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