Provider Demographics
NPI:1699487512
Name:HOGAN, BRANDON MICHAEL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:HOGAN
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 1:7100 COON ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ARENA
Mailing Address - State:WI
Mailing Address - Zip Code:53503-9306
Mailing Address - Country:US
Mailing Address - Phone:608-588-5859
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-280-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242459-30163WU0100X
WI14646-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WU0100XNursing Service ProvidersRegistered NurseUrology