Provider Demographics
NPI:1508979667
Name:MERRILEE R BRANDT MD PC
Entity Type:Organization
Organization Name:MERRILEE R BRANDT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-1273
Mailing Address - Street 1:110 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-1328
Mailing Address - Country:US
Mailing Address - Phone:989-362-1273
Mailing Address - Fax:989-362-2343
Practice Address - Street 1:110 E STATE ST
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-1328
Practice Address - Country:US
Practice Address - Phone:989-362-1273
Practice Address - Fax:989-362-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301 MB064187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4263135Medicaid
MIOP11990Medicare ID - Type Unspecified
MI4263135Medicaid