Provider Demographics
NPI:1316961113
Name:BRANDOW, AMANDA M (DO)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-277-8900
Mailing Address - Fax:414-456-6543
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-277-8900
Practice Address - Fax:414-456-6543
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI463332080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316961113Medicaid
WI43513300Medicaid
WI1316961113Medicaid
WI43513300Medicaid
WI092Q 73-601Medicare PIN