Provider Demographics
NPI:1912068305
Name:BRANDOW, MATTHEW (AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BRANDOW
Suffix:
Gender:M
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-0260
Mailing Address - Country:US
Mailing Address - Phone:906-475-7422
Mailing Address - Fax:906-486-6898
Practice Address - Street 1:100 MALTON ST
Practice Address - Street 2:STE 7
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2001
Practice Address - Country:US
Practice Address - Phone:906-475-7422
Practice Address - Fax:906-486-6898
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00110878OtherRRMEDICARE
MI540E210323OtherBCBS LICENSE
MI405176011Medicaid
MI904543700Medicaid
MI640E210300OtherBCBS LICENSE
MI405176011Medicaid