Provider Demographics
NPI:1548585045
Name:GENSON, BRANDON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:GENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N. MILFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1049
Mailing Address - Country:US
Mailing Address - Phone:248-676-9060
Mailing Address - Fax:
Practice Address - Street 1:1501 N. MILFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1049
Practice Address - Country:US
Practice Address - Phone:248-676-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine