Provider Demographics
NPI:1033162581
Name:SUEDEKUM, BRANDON K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:K
Last Name:SUEDEKUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3815 E BELL RD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2122
Mailing Address - Country:US
Mailing Address - Phone:602-258-4321
Mailing Address - Fax:623-889-2450
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:602-258-4321
Practice Address - Fax:623-889-2450
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME93606207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35451OtherAZ MEDICAL STATE LICENSE
AZ111212OtherMEDICARE ID
AZZWCHYMMedicare Oscar/Certification