Healthcare Provider Details

I. General information

NPI: 1497140453
Provider Name (Legal Business Name): NICHOLAS BRACCIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 W CAPITOL DR STE 101
MILWAUKEE WI
53222-1300
US

IV. Provider business mailing address

10012 W CAPITOL DR STE 101
MILWAUKEE WI
53222-1300
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-4844
  • Fax: 414-810-4845
Mailing address:
  • Phone: 414-810-4844
  • Fax: 414-810-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number66238-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: