MEDICARE: DR. THEODORE M BRAUN 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	208600000X	Surgery Physician	35038417	OH

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	:	1699778837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE M BRAUN MD

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	5TH FL
City	:	TOLEDO
State	:	OH
Zip	:	43604-7101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST
Second Line	:	1ST FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	419-251-5271
Fax Number	:	419-251-6977

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/02/2017

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