MEDICARE: BRANDON FREE

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	2086S0122X	Plastic and Reconstructive Surgery Physician	82403	MN
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1952939373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON FREE

Provider Business Mailing Address
First Line	:	303 E NICOLLET BLVD STE 330
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4594
Country	:	US
Telephone Number	:	952-209-9273
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E NICOLLET BLVD STE 330
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4594
Country	:	US
Telephone Number	:	952-209-9273
Fax Number	:

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	06/01/2026

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1013879162 — VITALIY PAVLOVICH KOVDIY
Practice Location Address:

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Directions to “ BRANDON FREE ” Practice Location

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