Provider Demographics
NPI:1912312406
Name:MENKE, BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MENKE
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 1:16820 FRANCES STREET SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2391
Mailing Address - Country:US
Mailing Address - Phone:402-933-6600
Mailing Address - Fax:409-933-7123
Practice Address - Street 1:16820 FRANCES STREET SUITE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2391
Practice Address - Country:US
Practice Address - Phone:402-933-6600
Practice Address - Fax:409-933-7123
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10120390200000X
SCLL38056207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program