Basic Information
| Provider Information | |||||||||
| NPI: | 1114970795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUER | ||||||||
| FirstName: | ERNESTO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY STE 315 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143854638 | ||||||||
| FaxNumber: | 4146496282 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY STE 315 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143854638 | ||||||||
| FaxNumber: | 4146496282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 25551 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 25551 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 30621600 | 05 | WI | MEDICAID | 090007900 | 05 | MN | MEDICAID |