Brandon J Manderle, MD
Family Medicine in Portage, MI. Individual provider (NPI-1).
NPI number1013576271
StatusActive
Last updated in NPPESJul 27, 2022
Details
- NPI
- 1013576271
- Entity type
- Individual (NPI-1)
- Name
- Brandon J Manderle
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 11, 2019
- Certification date
- Jul 27, 2022
- Last updated
- Jul 27, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 4301505916 | MI | Yes |
Practice location
2700 E Centre AvePortage, MI 49002-5500
Phone 269-286-7050
Mailing address
601 John StreetBox 39
Kalamazoo, MI 49007-1282
Other practice locations
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Kalamazoo, MI 49008-1282
Phone 269-349-2641
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