Healthcare Provider Details

I. General information

NPI: 1740784453
Provider Name (Legal Business Name): DR. MICHAEL BRAUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIR
JBPHH HI
96853-5399
US

IV. Provider business mailing address

403 CHRISTIAN LN
SLIDELL LA
70458-1356
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6132
  • Fax:
Mailing address:
  • Phone: 985-285-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number62611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: