Provider Demographics
NPI:1801080650
Name:WEST, BRANDON A (DPM JD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:WEST
Suffix:
Gender:M
Credentials:DPM JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21120 CONSTITUTION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5509
Mailing Address - Country:US
Mailing Address - Phone:248-624-1900
Mailing Address - Fax:
Practice Address - Street 1:1266 S COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3008
Practice Address - Country:US
Practice Address - Phone:248-624-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBW001378213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION80930Medicare PIN
MIT34365Medicare UPIN