MEDICARE: BRADEN DANIEL ENGSTROM

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	208000000X	Pediatrics Physician	4301514724	MI

General Provider Information

NPI Number	:	1649852971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADEN DANIEL ENGSTROM

Provider Business Mailing Address
First Line	:	2917 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9314
Country	:	US
Telephone Number	:	616-252-5437
Fax Number	:	616-252-5490

Provider Business Practice Location Address
First Line	:	2917 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9314
Country	:	US
Telephone Number	:	616-252-5437
Fax Number	:	616-252-5490

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	03/19/2026

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Directions to “ BRADEN DANIEL ENGSTROM ” Practice Location

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