Individual ProviderEvan BrandenburgStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address30 E Apple St Ste 6258, Dayton, OH 45409-2932(937) 208-8000PECOS EnrollmentBased on the most recent information from CMS, provider Evan Brandenburg is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1063202216Provider TypeIndividualFull NameBrandenburg, EvanGenderMaleSole ProprietorNoEnumeration Date5/10/2025Last Updated5/14/2025Contact InformationPractice LocationPractice Address30 E Apple St Ste 6258, Dayton, OH 45409-2932Phone(937) 208-8000FaxUnlisted FaxMailing LocationMailing Address30 E Apple St Ste 6258, Dayton, OH 45409-2932PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicense57.258989Ohio