Provider Demographics
NPI:1639222425
Name:BRANDNER, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:BRANDNER
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:PO BOX 232711
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-2711
Mailing Address - Country:US
Mailing Address - Phone:907-272-9991
Mailing Address - Fax:907-279-9991
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-272-9991
Practice Address - Fax:907-279-9991
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34782086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3478Medicaid
AK0000BLBRMMedicare ID - Type Unspecified
AKMD3478Medicaid