Healthcare Provider Details

I. General information

NPI: 1912343823
Provider Name (Legal Business Name): TRACY BRAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19525 W NORTH AVE
BROOKFIELD WI
53045-4107
US

IV. Provider business mailing address

9310 S 46TH ST
FRANKLIN WI
53132-9273
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number84058-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number84058-20
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD22373
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: