Provider Demographics
NPI:1235102872
Name:BRANDENBURG, ELIZABETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6008 ST MORITZ DR
Mailing Address - Street 2:UNIT K
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-5287
Mailing Address - Country:US
Mailing Address - Phone:406-407-0009
Mailing Address - Fax:209-536-3565
Practice Address - Street 1:1600 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-863-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG053595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD38237Medicare UPIN