Individual
DR. GWEN MARIE BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 JEFFERSON SE, STE 549, GRAND RAPIDS, MI 49503
(616) 685-1835
(616) 685-1846
Mailing address
245 STATE ST SE, STE 228, GRAND RAPIDS, MI 49503
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301085852
MI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
4301085852
MI
Other
Enumeration date
01/28/2007
Last updated
06/14/2011
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