MEDICARE: DR. ARLENE MAGON BRAKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	29240-020	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045273840	OTHER	WI	MEDICARE PTAN

General Provider Information

NPI Number	:	1295722320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARLENE MAGON BRAKER M.D.

Provider Business Mailing Address
First Line	:	9252 N GREEN BAY RD
Second Line	:
City	:	BROWN DEER
State	:	WI
Zip	:	53209-1104
Country	:	US
Telephone Number	:	414-527-5089
Fax Number	:	414-365-6349

Provider Business Practice Location Address
First Line	:	9252 N GREEN BAY RD
Second Line	:
City	:	BROWN DEER
State	:	WI
Zip	:	53209-1104
Country	:	US
Telephone Number	:	414-527-5089
Fax Number	:	414-365-6349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/28/2014

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