Healthcare Provider Details

I. General information

NPI: 1457390577
Provider Name (Legal Business Name): JAMES BRAUNLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7526 E 82ND ST STE 125
INDIANAPOLIS IN
46256-1467
US

IV. Provider business mailing address

PO BOX 12812
BELFAST ME
04915-4040
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01060817
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: