Basic Information
Provider Information
NPI: 1659515732
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRAUN
FirstName: CHARLES
MiddleName: NATHAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DR
Address2: PO BOX 0446 LOBBY J
City: ANN ARBOR
State: MI
PostalCode: 481059484
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber: 7342223100
Practice Location
Address1: 5333 MCAULEY DR
Address2: STE 6109
City: YPSILANTI
State: MI
PostalCode: 481971014
CountryCode: US
TelephoneNumber: 7347121400
FaxNumber: 7347121670
Other Information
ProviderEnumerationDate: 04/21/2009
LastUpdateDate: 07/01/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X4301102475MIY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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