Healthcare Provider Details

I. General information

NPI: 1629231816
Provider Name (Legal Business Name): CATHERINE BRANKIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE G400
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax:
Mailing address:
  • Phone: 850-505-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS14124
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberOS14124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: