Provider Demographics
NPI:1194390310
Name:ELLIOTT, BRANDON G
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:G
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WHITETAIL CREEK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5896
Mailing Address - Country:US
Mailing Address - Phone:989-270-1325
Mailing Address - Fax:989-204-4816
Practice Address - Street 1:33 WHITETAIL CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5896
Practice Address - Country:US
Practice Address - Phone:989-270-1325
Practice Address - Fax:989-204-4816
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301512389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine