Individual
BRANDON M WEGENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 GARWOOD ST, MT PLEASANT, MI 48858-3210
(517) 420-8173
Mailing address
705 GARWOOD ST, MT PLEASANT, MI 48858-3210
(517) 420-8173
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010880
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2021
Last updated
10/15/2021
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