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General NPI Number Information
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NPI Number | 1780926212
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Entity Type | Individual
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Provider Name | NICHOLAS C BRAUTIGAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 9000 N MAIN ST
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City | ENGLEWOOD
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State | OH
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Zip | 45415
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Country | US
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Telephone | 937-734-9530
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Fax |
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Provider Business Mailing Address
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Address Line | 10949 SHALLOW CREEK CT
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City | CENTERVILLE
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State | OH
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Zip | 45458-7501
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Country | US
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Telephone | 806-445-1500
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Fax | 806-445-1500
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35.127322
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License Number State | OH
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