Provider Demographics
NPI:1245530823
Name:BUSKIRK, BRANDI JONEE (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:JONEE
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 5TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4912
Mailing Address - Fax:810-424-6029
Practice Address - Street 1:4001 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-3994
Practice Address - Country:US
Practice Address - Phone:810-789-9141
Practice Address - Fax:810-789-9222
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-1806OtherMEDICARE PART A
MI1386624278OtherGROUP NPI
MI0B56065OtherMEDICARE PART B