Provider Demographics
NPI:1841510765
Name:BRANDT, SEAN KATHLEEN (DO)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:KATHLEEN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5629 STADIUM DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1952
Mailing Address - Country:US
Mailing Address - Phone:269-372-5701
Mailing Address - Fax:269-372-5702
Practice Address - Street 1:5629 STADIUM DR
Practice Address - Street 2:SUITE D
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1952
Practice Address - Country:US
Practice Address - Phone:269-372-5701
Practice Address - Fax:269-372-5702
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2014-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine