Provider Demographics
NPI:1316055866
Name:GENDELMAN, BRIAN S (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:GENDELMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8896 COMMERCE RD
Mailing Address - Street 2:STE 5
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382
Mailing Address - Country:US
Mailing Address - Phone:248-360-9241
Mailing Address - Fax:284-360-0830
Practice Address - Street 1:8896 COMMERCE RD
Practice Address - Street 2:STE 5
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382
Practice Address - Country:US
Practice Address - Phone:248-360-9241
Practice Address - Fax:284-360-0830
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301051241208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42065Medicare UPIN