Provider Demographics
NPI:1740271162
Name:BRANDT, ROLAND (DO)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:BRANDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLIAM CARLS DR
Mailing Address - Street 2:RSC
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2201
Mailing Address - Country:US
Mailing Address - Phone:248-937-4947
Mailing Address - Fax:248-937-5150
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:RSC
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-4947
Practice Address - Fax:248-937-5150
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4127008 TYPE 11Medicaid
MI4127017 TYPE 11Medicaid
MI5606110001OtherADMINISTAR FED DME RSC
MIC5548OtherMCARE
MI5606110003OtherADMINISTAR FED DME HARTLAND
MI4518251OtherAETNA
MI2056305914OtherBCBSM PIN
MI502919OtherCARE CHCS/PREF CHCS
MI4127017 TYPE 11Medicaid
MI4518251OtherAETNA