MEDICARE: DR. STEPHANIE ANN BRANAM D.O.

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	207RR0500X	Rheumatology Physician	5101020011	MI
2	207R00000X	Internal Medicine Physician	5101020011	MI

General Provider Information

NPI Number	:	1750642831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ANN BRANAM D.O.

Provider Business Mailing Address
First Line	:	844 WASHINGTON AVE STE 1200
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7186
Country	:	US
Telephone Number	:	616-393-5336
Fax Number	:	616-392-2889

Provider Business Practice Location Address
First Line	:	844 WASHINGTON AVE STE 1200
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7186
Country	:	US
Telephone Number	:	616-393-5336
Fax Number	:	616-392-2889

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	01/16/2024

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