MEDICARE: MR. DANA R BRACKINS II P.A.C

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
1	363A00000X	Physician Assistant	5601002366	MI

General Provider Information

NPI Number	:	1114002417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANA R BRACKINS II P.A.C

Provider Business Mailing Address
First Line	:	9249 W LAKE CITY RD
Second Line	:	MID MICHIGAN HEALTH SERVICES
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-8902
Country	:	US
Telephone Number	:	989-422-5122
Fax Number	:	989-422-4378

Provider Business Practice Location Address
First Line	:	9249 W LAKE CITY RD
Second Line	:	MID MICHIGAN HEALTH SERVICES
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-8902
Country	:	US
Telephone Number	:	989-422-5122
Fax Number	:	989-422-4378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/24/2009

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