Provider Demographics
NPI:1396878054
Name:GAETINO, BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:GAETINO
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 1:2006 HOGBACK RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9750
Mailing Address - Country:US
Mailing Address - Phone:734-263-2395
Mailing Address - Fax:734-773-3471
Practice Address - Street 1:2006 HOGBACK RD STE 5A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9750
Practice Address - Country:US
Practice Address - Phone:734-263-2395
Practice Address - Fax:734-773-3471
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089293207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0508145512OtherBLUE CROSS BULE SHIELD MI
MIN77130007Medicare PIN
MIN76360009Medicare PIN