Provider Demographics
NPI:1386113215
Name:REDOUTE, BRANDON BRUCE (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:BRUCE
Last Name:REDOUTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23516 HARVARD SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4339
Mailing Address - Country:US
Mailing Address - Phone:586-214-5028
Mailing Address - Fax:
Practice Address - Street 1:37150 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-2702
Practice Address - Country:US
Practice Address - Phone:586-267-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical