Provider Demographics
NPI:1982899506
Name:BRANDON A WEST DPM JD PLLC
Entity Type:Organization
Organization Name:BRANDON A WEST DPM JD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM JD
Authorized Official - Phone:248-624-1900
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBW001378213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION80930Medicare PIN
MIT34365Medicare UPIN