MEDICARE: LARRY BRAVER DO PC

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	207Q00000X	Family Medicine Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568631315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY BRAVER DO PC

Provider Business Mailing Address
First Line	:	8245 HOLLY RD
Second Line	:	STE 102A
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2443
Country	:	US
Telephone Number	:	810-694-0300
Fax Number	:	810-694-0710

Provider Business Practice Location Address
First Line	:	8245 HOLLY RD
Second Line	:	STE 102A
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2443
Country	:	US
Telephone Number	:	810-694-0300
Fax Number	:	810-694-0710

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY BRAVER
Credential	:	DO
Telephone Number	:	810-694-0300

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	11/13/2012

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Directions to “LARRY BRAVER DO PC ” Practice Location

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