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NPI Code Detail

MEDICARE: MR. MICHAEL J BRAID ATC

MEDICARE: MR. MICHAEL J BRAID ATC
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
12255A2300XAthletic Trainer2601000200MI

General Provider Information

NPI Number : 1841268372
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL J BRAID ATC
Provider Business Mailing Address
First Line : 18000 COVE STREET
Second Line : SUITE 202
City : SPRING LAKE
State : MI
Zip : 49456-1383
Country : US
Telephone Number : 616-847-1280
Fax Number : 616-847-1290
Provider Business Practice Location Address
First Line : 18000 COVE STREET
Second Line : SUITE 202
City : SPRING LAKE
State : MI
Zip : 49456-1383
Country : US
Telephone Number : 616-847-1280
Fax Number : 616-847-1290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 07/01/2014

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