Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125053218 | IL |
N | 111NI0900X | Internist | 125053218 | IL |
N | 207RH0003X | Hematology & Oncology | 01072837A | IN |
Y | 207RX0202X | Medical Oncology | 01072837A | IN |
NPI | 1144486309 |
---|---|
Provider Name | Eduardo Braun |
First Address | South Bend, IN 46601-2349 |
Second Address | Westville, IN 46391-9523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 03/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200340290 | (05) | IN |