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General NPI Number Information
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NPI Number | 1376167536
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Entity Type | Individual
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Provider Name | GINA BRAVATA MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE N1200
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City | KALAMAZOO
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State | MI
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Zip | 49007-5318
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Country | US
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Telephone | 269-341-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 OAKLAND DR
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City | KALAMAZOO
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State | MI
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Zip | 49008-1282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4351046939
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 4301512651
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License Number State | MI
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