MR. BRANDON C. WAGENAAR (NPI# 1346638566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346638566 |
| Entity Type | Individual |
| Full Name | MR. BRANDON C. WAGENAAR |
| Credential | CSA, MS |
| Practice Address |
1245 S Michigan Ave Ste 215 Chicago IL 60605-2408 |
| Mailing Address |
1245 S. Michigan Avenue Suite 215 Chicago IL 60605 |
| Practice Telephone | 2021234567 |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2020-07-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | Other Service Providers | ||
| N | 246ZC0007X |
Specialist/Technologist, Other Specialization: Surgical Assistant |
0136000233 | VA | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
1245 S MICHIGAN AVE STE 215 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60605-2408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568074219 | Kheri Dunkins | Counselor | 1136 S Delano Ct, Suite B201, Chicago, IL 60605 | 2020-08-22 |
| 1134739196 | Erin Odonnell | Physical Therapist | 1255 Soputh State Street, Unit 6, Chicago, IL 60605 | 2020-08-05 |
| 1225658032 | Rita Haber | Speech-Language Pathologist | 1255 S Michigan Avenue, 207, Chicago, IL 60605 | 2020-04-21 |
| 1285288753 | My Travel Guy, Inc. | Transportation Broker | 1300 S. Wabash Ave. Suite # 205, Chicago, IL 60605 | 2019-08-01 |
| 1699230417 | Iesha Marsh | Home Health Aide | 820 S Park Terrance, Apt813, Chicago, IL 60605 | 2019-02-06 |
| 1538633482 | Sara Miller | Counselor | 401 S. Lasalle St. Suite 800h, Chicago, IL 60605 | 2019-01-14 |
| 1992203798 | Lorna Johnson | Nurse Practitioner | 1740 W Taylor St., 764e Uih, Mc 509, Chicago, IL 60605 | 2018-01-26 |
| 1790226207 | Undine and Associates | Social Worker | 410 S. Michigan Ave, Ste 943, Chicago, IL 60605 | 2017-03-16 |
| 1659811529 | Paul Parpart | Occupational Therapist | 1235 S Prairie, Chicago, IL 60605 | 2017-02-27 |
| 1144679879 | Osco Drug | Ambulance | 1529 S State St 6e, Chicago, IL 60605 | 2016-06-03 |
| Find all providers in zip 60605 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235430737 | Megan Elizabeth Schelp | Military Health Care Provider | 5820 N Kenmore Ave, Apartment 404, Chicago, IL 60660-3765 | 2010-11-15 |
| 1144281882 | Luningning Gayapa Madamba | Military Health Care Provider | 5332 N Kildare Ave, Chicago, IL 60630-1759 | 2006-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669869764 | Benjamin Pittman | Military Health Care Provider | Uss Tranquility (bhc 1007), Capt James A Lovell Federal Health Care Center, North Chicago, IL 60064 | 2015-04-16 |
| 1932434339 | Tasha Oakley | Military Health Care Provider | 104 Kenwood Ct Apt 1, Normal, IL 61761-4707 | 2009-10-02 |
| 1861512501 | Leigh Karole Grannan | Military Health Care Provider | 625 Wham Dr - Mailcode 6607, Center for Autism Spectrum Disorders, Carbondale, IL 62901-4313 | 2007-03-29 |
| 1215033790 | Jerzy Feliks Zadecki | Military Health Care Provider | 930 Mapleton Ave, Oak Park, IL 60302-1404 | 2006-09-15 |
| 1073575692 | Teresita Hernandez Huang | Military Health Care Provider | 3450 Riverside Dr, Wilmette, IL 60091-1062 | 2006-04-06 |
| 1154380947 | Eden U Padilla | Military Health Care Provider | Uss Red Rover, Recruit Training Center, Great Lakes, IL 60088 | 2006-03-21 |
| 1225439045 | Erin O'connor | Military Health Care Provider | 310 W Losey St, Scott Air Force Base, IL 62225-5250 | 2014-09-11 |
| 1376704783 | Richard Neal Craig | Military Health Care Provider | 2401 W Main St, Va Medical Center, Marion, IL 62959-1188 | 2008-06-18 |
| 1518084359 | Dolores Delacruz Lindsey | Military Health Care Provider | 111 N County Farm Rd, Wheaton, IL 60187-3977 | 2007-03-26 |
| 1427021807 | Jeffrey Allan Damaschke | Military Health Care Provider | 3001 6th St, Physical Therapy Department, Great Lakes, IL 60088-2833 | 2006-02-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.