Provider Demographics
NPI:1194304964
Name:SAVAGE, BRANDON MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATTHEW
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46598 W RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3581
Mailing Address - Country:US
Mailing Address - Phone:586-256-1363
Mailing Address - Fax:
Practice Address - Street 1:46598 W RIDGE DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3581
Practice Address - Country:US
Practice Address - Phone:586-256-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA338517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program