Basic Information
Provider Information
NPI: 1720346620
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOKS
FirstName: BRANDON
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16001 W 9 MILE RD
Address2: GRADUATE MEDICAL EDUATION
City: SOUTHFIELD
State: MI
PostalCode: 480754818
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1 GENESYS PKWY
Address2: GRADUATE MEDICAL EDUATION
City: GRAND BLANC
State: MI
PostalCode: 484398065
CountryCode: US
TelephoneNumber: 8106065000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/27/2012
LastUpdateDate: 05/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X5101019715MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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