Provider Demographics
NPI:1417944604
Name:BRANDT, TODD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:BRANDT
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 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1712
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1712
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6830
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42484208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340018335OtherRR MEDICARE
MN388643300Medicaid
MN340000646Medicare PIN
MN388643300Medicaid