Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301071125 | MI |
N | 208600000X | Surgeon | 4301071125 | MI |
Y | 2086S0102X | Surgical Critical Care | 4301071125 | MI |
NPI | 1053474676 |
---|---|
Provider Name | Mary-Margaret Brandt |
First Address | Ann Arbor, MI 48106 |
Second Address | Ypsilanti, MI 48197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 23/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
469496610 | (05) | MI |
700H262310 | BLUE CROSS-BLUE CROSS (01) | |
G59157 | (02) | |
MB071125 | CHAMPUS-CHAMPUS (01) | |
MB071125 | COMMERCIAL-COMMERCIAL NUMBER (01) |