Provider Demographics
NPI:1003415514
Name:HUDSON, BRANDON M
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:HUDSON
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 1:314 PARK LANE CIR
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9675
Mailing Address - Country:US
Mailing Address - Phone:563-542-3669
Mailing Address - Fax:
Practice Address - Street 1:185 N FRANKLIN ST FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1932
Practice Address - Country:US
Practice Address - Phone:608-790-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies