Healthcare Provider Details

I. General information

NPI: 1407854409
Provider Name (Legal Business Name): ENRICO BRAUCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6112 E BLUFFVIEW RD
IRONWOOD MI
49938-9367
US

IV. Provider business mailing address

N10565 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-2231
  • Fax: 906-932-2620
Mailing address:
  • Phone: 906-932-1500
  • Fax: 906-932-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301069420
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: