Provider Demographics
NPI:1255431946
Name:BRANDRETH, DAVID LEONARD (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEONARD
Last Name:BRANDRETH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6199 MILLER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1585
Mailing Address - Country:US
Mailing Address - Phone:810-635-0554
Mailing Address - Fax:810-635-0558
Practice Address - Street 1:6199 MILLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1585
Practice Address - Country:US
Practice Address - Phone:810-635-0554
Practice Address - Fax:810-635-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001472213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1983802Medicaid
MI5251018OtherBLUE CROSS BLUE SHIELD
MI1983802Medicaid
MI5251018OtherBLUE CROSS BLUE SHIELD
MI5255223Medicare PIN