Healthcare Provider Details

I. General information

NPI: 1922096551
Provider Name (Legal Business Name): STEVEN K. BRANCH M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 120
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

295 MAPLE ST STE 200
TAWAS CITY MI
48763-9352
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7310
  • Fax:
Mailing address:
  • Phone: 989-984-3788
  • Fax: 989-984-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number221276
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: