Provider Demographics
NPI:1407854409
Name:BRAUCHER, ENRICO (MD)
Entity Type:Individual
Prefix:
First Name:ENRICO
Middle Name:
Last Name:BRAUCHER
Suffix:
Gender:M
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:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:906-932-5630
Practice Address - Street 1:E6112 E BLUFFVIEW RD
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9367
Practice Address - Country:US
Practice Address - Phone:906-932-2231
Practice Address - Fax:906-932-2620
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069420208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31966800Medicaid
383005582001OtherHEALTHNET FEDERAL SERVICE
MI4436470Medicaid
MIEB069420OtherBLUE CROSS BLUE SHIELD MI
020053604OtherPALMETTO GBA
MN123M6BROtherBCBS
MI700B710030OtherBCBS
1032245OtherPREFERREDONE
1032245OtherPREFERREDONE
MIEB069420OtherBLUE CROSS BLUE SHIELD MI