Healthcare Provider Details

I. General information

NPI: 1356786800
Provider Name (Legal Business Name): KELLY LAUREN BRAUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE # 420
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-2800
  • Fax:
Mailing address:
  • Phone: 602-406-7765
  • Fax: 602-294-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number56547
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1356786800
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number56547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: