Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036103178 | IL |
NPI | 1023022555 |
---|---|
Provider Name | Michael G Braun |
First Address | Barrington, IL 60010-0098 |
Second Address | Barrington, IL 60010-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103178 | (05) | IL |
H28001 | (02) | |
P00197717 | RAILROAD MEDICARE (01) | IL |