MEDICARE: MERRILEE R BRANDT MD PC

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	174400000X	Specialist	4301 MB064187	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

General Provider Information

NPI Number	:	1508979667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRILEE R BRANDT MD PC

Provider Business Mailing Address
First Line	:	110 E STATE ST
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-1328
Country	:	US
Telephone Number	:	989-362-1273
Fax Number	:	989-362-2343

Provider Business Practice Location Address
First Line	:	110 E STATE ST
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-1328
Country	:	US
Telephone Number	:	989-362-1273
Fax Number	:	989-362-2343

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PATTI ANDERSEN
Credential	:
Telephone Number	:	989-362-1273

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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