MEDICARE: DR. EARL ALBERT BRAUNLIN MD

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	207W00000X	Ophthalmology Physician	01018005A	IN

General Provider Information

NPI Number	:	1568456549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EARL ALBERT BRAUNLIN MD

Provider Business Mailing Address
First Line	:	717 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-4002
Country	:	US
Telephone Number	:	260-426-3494
Fax Number	:	260-426-3495

Provider Business Practice Location Address
First Line	:	717 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-4002
Country	:	US
Telephone Number	:	260-426-3494
Fax Number	:	260-426-3495

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	04/06/2008

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