Individual
MR. MATTHEW BRANDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUDIOLOGIST
Contact information
Practice address
100 MALTON ST, STE 7, NEGAUNEE, MI 49866-2001
(906) 475-7422
(906) 486-6898
Mailing address
PO BOX 260, ISHPEMING, MI 49849-0260
(906) 475-7422
(906) 486-6898
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1601000055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405176011
—
MI
01
—
540E210323
BCBS LICENSE
MI
01
—
640E210300
BCBS LICENSE
MI
05
—
904543700
—
MI
01
—
P00110878
RRMEDICARE
MI
Enumeration date
12/12/2006
Last updated
04/28/2008
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