Healthcare Provider Details

I. General information

NPI: 1245345073
Provider Name (Legal Business Name): HUGH F BRAINARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 MILLENNIUM SUITE 100
LANSING MI
48917-6880
US

IV. Provider business mailing address

6465 MILLENNIUM DRIVE SUITE 100
LANSING MI
48917-6880
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-3720
  • Fax: 517-975-3748
Mailing address:
  • Phone: 517-975-3720
  • Fax: 517-975-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberHB072510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: