Provider Demographics
NPI:1386827152
Name:KEVIN E. BRAUN, MD PLLC
Entity Type:Organization
Organization Name:KEVIN E. BRAUN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCINROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-584-3023
Mailing Address - Street 1:5920 100TH ST SW
Mailing Address - Street 2:31
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-584-3023
Mailing Address - Fax:253-582-1222
Practice Address - Street 1:5920 100TH ST SW
Practice Address - Street 2:31
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-584-3023
Practice Address - Fax:253-582-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1200013Medicaid
WA1200013Medicaid
WAG8855228Medicare PIN