Provider Demographics
NPI:1629241559
Name:HOLDA, BRANDON CHARLES
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHARLES
Last Name:HOLDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43401 N. JEFFERSON BLDG #825
Mailing Address - Street 2:
Mailing Address - City:SELFRIDGE ANGB
Mailing Address - State:MI
Mailing Address - Zip Code:48045
Mailing Address - Country:US
Mailing Address - Phone:586-307-5017
Mailing Address - Fax:586-307-5010
Practice Address - Street 1:43401 N. JEFFERSON BLDG #825
Practice Address - Street 2:
Practice Address - City:SELFRIDGE ANGB
Practice Address - State:MI
Practice Address - Zip Code:48045
Practice Address - Country:US
Practice Address - Phone:586-307-5017
Practice Address - Fax:586-307-5010
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other