Provider Demographics
NPI:1033373295
Name:BRAND, PATRICK J (AUD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:BRAND
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PARK PLACE CIR STE 360
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3564
Mailing Address - Country:US
Mailing Address - Phone:574-243-7766
Mailing Address - Fax:574-288-7143
Practice Address - Street 1:425 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3563
Practice Address - Country:US
Practice Address - Phone:574-243-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-1657231H00000X
IN23002591A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7387831Medicare PIN