Basic Information
| Provider Information | |||||||||
| NPI: | 1396762399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUNAGEL | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5690 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 16061 | 05 | ND | MEDICAID | 16318 | 05 | ND | MEDICAID |