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General NPI Number Information
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NPI Number | 1730255357
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Entity Type | Individual
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Provider Name | KRISTEN J BRACKLEIN D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 900 BLOOD RD
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City | TECUMSEH
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State | MI
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Zip | 49286-9575
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Country | US
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Telephone | 432-212-2944
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Fax | 734-661-0406
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Provider Business Mailing Address
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Address Line | 7700 CODY LN APT3306
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City | SACHSE
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State | TX
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Zip | 75048-6629
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101012874
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K5173
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO205724
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License Number State | OR
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