Provider Demographics
NPI:1437463619
Name:NACEWICZ, BRENDON (MD, PHD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:NACEWICZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 GRAND TETON PLZ STE 107
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6502 GRAND TETON PLZ STE 107
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1047
Practice Address - Country:US
Practice Address - Phone:608-820-1570
Practice Address - Fax:608-305-8848
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60947-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry