Provider Demographics
NPI:1518475730
Name:LUEDTKE, BRANDON ARTHUR (PA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ARTHUR
Last Name:LUEDTKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3085 HALLMARK CT STE 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-6803
Mailing Address - Country:US
Mailing Address - Phone:989-996-0566
Mailing Address - Fax:989-401-2876
Practice Address - Street 1:3085 HALLMARK CT STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6803
Practice Address - Country:US
Practice Address - Phone:989-996-0566
Practice Address - Fax:989-401-2876
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4400363A00000X, 363A00000X
MI5601008544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant