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General NPI Number Information
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NPI Number | 1851629703
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Entity Type | Individual
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Provider Name | STACIE BRASWELL MD
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Gender | Female
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 1313 W CHICAGO AVE
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3316
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Country | US
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Telephone | 219-398-9685
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Fax | 219-398-9695
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Provider Business Mailing Address
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Address Line | 951 TRANSPORT DR
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City | VALPARAISO
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State | IN
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Zip | 46383-8434
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Country | US
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Telephone | 219-477-6082
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Fax | 219-465-9502
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01073089A
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License Number State | IN
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