Provider Demographics
NPI:1053474676
Name:BRANDT, MARY-MARGARET (MD, MHSA)
Entity Type:Individual
Prefix:
First Name:MARY-MARGARET
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MD, MHSA
Other - Prefix:
Other - First Name:MARY-MARGARET
Other - Middle Name:
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 0446 LOBBY J
Mailing Address - Street 2:24 FRANK LLOYD WRIGHT DR.
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-712-2808
Mailing Address - Fax:734-712-2844
Practice Address - Street 1:5301 E. HURON RIVER DR.
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-7017
Practice Address - Fax:734-712-2844
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071125208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI469496610Medicaid
700H262310OtherBLUE CROSS-BLUE CROSS
MB071125OtherCOMMERCIAL-COMMERCIAL NUMBER
MB071125OtherCHAMPUS-CHAMPUS
MB071125OtherCHAMPUS-CHAMPUS
0H26231115Medicare ID - Type Unspecified