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NPI Code Detail

MEDICARE: DAVID ALAN BRANDT M.D.

MEDICARE: DAVID ALAN BRANDT 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
1207R00000XInternal Medicine Physician036-112714IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11629004965OTHERILNPI

General Provider Information

NPI Number : 1629004965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID ALAN BRANDT M.D.
Provider Business Mailing Address
First Line : PO BOX 746721
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6721
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 4318 S STATE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60609-3701
Country : US
Telephone Number : 773-285-9304
Fax Number : 773-564-3501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 02/17/2023

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Directions to “ DAVID ALAN BRANDT M.D.” Practice Location

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