Provider Demographics
NPI:1104037167
Name:BRANAM, KAREN PAGE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PAGE
Last Name:BRANAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GREEN GLADES
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8662
Mailing Address - Country:US
Mailing Address - Phone:305-815-1133
Mailing Address - Fax:
Practice Address - Street 1:160 GREEN GLADES
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8662
Practice Address - Country:US
Practice Address - Phone:305-815-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21915207L00000X
LAMD.203567207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01245539OtherRR MEDICARE
LA09200Medicaid
AL138266Medicaid
AL138266Medicaid
MS302I050373Medicare PIN