Provider Demographics
NPI:1114069838
Name:BRANHAM, GREGG DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:DEAN
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 ULSTER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS,
Mailing Address - State:MI
Mailing Address - Zip Code:48309
Mailing Address - Country:US
Mailing Address - Phone:248-375-2551
Mailing Address - Fax:586-949-0206
Practice Address - Street 1:2385 ULSTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2040
Practice Address - Country:US
Practice Address - Phone:248-375-2551
Practice Address - Fax:586-949-0206
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine