MEDICARE: TROY BRANIGAN II

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	172A00000X	Driver	59184	IN

General Provider Information

NPI Number	:	1891905634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY BRANIGAN II

Provider Business Mailing Address
First Line	:	2511 BARONET CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6801
Country	:	US
Telephone Number	:	260-740-6292
Fax Number	:	260-484-4174

Provider Business Practice Location Address
First Line	:	2511 BARONET CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6801
Country	:	US
Telephone Number	:	260-740-6292
Fax Number	:	260-484-4174

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/09/2007

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Directions to “ TROY BRANIGAN II ” Practice Location

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