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NPI Code Detail

MEDICARE: TIMOTHY P. BRAATZ M.D.

MEDICARE: TIMOTHY P. BRAATZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician254865MA
22085R0202XDiagnostic Radiology PhysicianMD421094PA

General Provider Information

NPI Number : 1073526240
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY P. BRAATZ M.D.
Provider Business Mailing Address
First Line : 1000 EAST MOUNTAIN DR
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711
Country : US
Telephone Number : 570-214-5681
Fax Number : 570-271-6578
Provider Business Practice Location Address
First Line : 3600 MINNESOTA DR STE 800
Second Line :
City : EDINA
State : MN
Zip : 55435-7915
Country : US
Telephone Number : 952-595-1301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 06/02/2026

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