Provider Demographics
NPI:1619132420
Name:MUSGRAVE, BRANDON KEITH (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:KEITH
Last Name:MUSGRAVE
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 1:1375 E WOODFIELD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5423
Mailing Address - Country:US
Mailing Address - Phone:847-882-5888
Mailing Address - Fax:847-882-5951
Practice Address - Street 1:1375 E WOODFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5423
Practice Address - Country:US
Practice Address - Phone:847-882-5888
Practice Address - Fax:847-882-5951
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091822207Y00000X
IL036.132275207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology