Basic Information
| Provider Information | |||||||||
| NPI: | 1629241559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLDA | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43401 N. JEFFERSON BLDG #825 | ||||||||
| Address2: | |||||||||
| City: | SELFRIDGE ANGB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863075017 | ||||||||
| FaxNumber: | 5863075010 | ||||||||
| Practice Location | |||||||||
| Address1: | 43401 N. JEFFERSON BLDG #825 | ||||||||
| Address2: | |||||||||
| City: | SELFRIDGE ANGB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863075017 | ||||||||
| FaxNumber: | 5863075010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.