Provider Demographics
NPI:1366677437
Name:KAKOS, BRANDON SAM (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:SAM
Last Name:KAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28300 ORCHARD LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3704
Mailing Address - Country:US
Mailing Address - Phone:248-539-8638
Mailing Address - Fax:
Practice Address - Street 1:28300 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3704
Practice Address - Country:US
Practice Address - Phone:248-539-8638
Practice Address - Fax:248-539-9045
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35098143207XX0005X
MI4301109849207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366677437Medicaid