Provider Demographics
NPI:1417340837
Name:SACHWITZ, BRANDON LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:SACHWITZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 KOLA ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:IA
Mailing Address - Zip Code:50070-7510
Mailing Address - Country:US
Mailing Address - Phone:651-233-8298
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH STREET
Practice Address - Street 2:TRINITY MEDICAL CENTER
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-779-2754
Practice Address - Fax:309-779-2755
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant