Provider Demographics
NPI:1386904035
Name:BRECHTELSBAUER, BRANDI SUE (DPM)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:BRECHTELSBAUER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:316 S COLUMBIAN ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2906
Mailing Address - Country:US
Mailing Address - Phone:989-686-2331
Mailing Address - Fax:
Practice Address - Street 1:316 S COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2906
Practice Address - Country:US
Practice Address - Phone:989-686-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002435213E00000X
WV10432213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist