Brautigan, Mark W

Brautigan, Mark W is an individual health care provider with primary practice located at 6071 W Outer Dr , Detroit MI 48235-2624. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Brautigan, Mark W can be contacted via phone (313) 966-3300.

Contact Information

Primary practice address
6071 W Outer Dr Detroit MI 48235-2624
Phone: (313) 966-3300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 4301041450 Michigan
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 4301041450 Michigan

Profile Details

NPI number 1760442586
LBN Legal business name Brautigan, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated Jun 18th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760442586 NPPES
Michigan Other MB041450 BC/BS OF MI
Michigan MEDICAID 102657444 BC/BS OF MI

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