MEDICARE: BEVERLY L BRAAK M.D.

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	207V00000X	Obstetrics & Gynecology Physician	11310	MT
2	207V00000X	Obstetrics & Gynecology Physician	33235	WI

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	:	1922054550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY L BRAAK M.D.

Provider Business Mailing Address
First Line	:	2831 FORT MISSOULA RD
Second Line	:	203
City	:	MISSOULA
State	:	MT
Zip	:	59804-7419
Country	:	US
Telephone Number	:	406-327-3875
Fax Number	:	406-327-3876

Provider Business Practice Location Address
First Line	:	2835 FORT MISSOULA RD
Second Line	:	203
City	:	MISSOULA
State	:	MT
Zip	:	59804-7423
Country	:	US
Telephone Number	:	406-327-3875
Fax Number	:	406-327-3876

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/25/2015

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Practice Location Address:

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Practice Location Address:

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Directions to “ BEVERLY L BRAAK M.D.” Practice Location

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