Healthcare Provider Details

I. General information

NPI: 1033646427
Provider Name (Legal Business Name): CASEY BRANACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLIAM CARLS DR STE 230
COMMERCE TOWNSHIP MI
48382-2201
US

IV. Provider business mailing address

PO BOX 18898
BELFAST ME
04915-4083
US

V. Phone/Fax

Practice location:
  • Phone: 248-270-5547
  • Fax: 248-694-2040
Mailing address:
  • Phone: 469-803-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC1-0027719
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301500654
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0027719
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: