Provider Demographics
NPI:1154327252
Name:ROSS, BRANDON (MD)
Entity Type:Individual
Prefix:MRS
First Name:BRANDON
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E WATTLES RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7008
Mailing Address - Country:US
Mailing Address - Phone:248-524-2121
Mailing Address - Fax:248-524-2035
Practice Address - Street 1:2950 E WATTLES RD
Practice Address - Street 2:STE 300
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7008
Practice Address - Country:US
Practice Address - Phone:248-524-2121
Practice Address - Fax:248-524-2035
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBR407448174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF31055Medicare UPIN