Doctor Name: | MR. BRANDON SETH LONGENECKER |
NPI Number: | 1407196801 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 15855 Nineteen Mile Road Henry Ford Macomb Hospitals Clinton Township, MI - 48038 |
Business Phone Number: | 5862632950 |
Business Fax Number: | 5862632975 |
Mailing Address: | 15855 Nineteen Mile Road, Henry Ford Macomb Hospitals CLINTON TOWNSHIP |
State: | MI |
Postal Code: | 48038 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/21/2013 |
NPI Last Update Date: | 02/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |