Provider Demographics
NPI:1447991617
Name:COY, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:COY
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 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:10020 PROFESSIONAL CENTRE DR
Practice Address - Street 2:STE 120
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-0252
Practice Address - Fax:810-231-0256
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101028410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program