Provider Demographics
NPI:1467404970
Name:BRAZA, DIANE W (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:W
Last Name:BRAZA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:SPINE CARE CLINIC AT PLANK ROAD
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3421
Mailing Address - Country:US
Mailing Address - Phone:414-955-7199
Mailing Address - Fax:414-955-0110
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:SPINE CARE CLINIC AT PLANK ROAD
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3421
Practice Address - Country:US
Practice Address - Phone:414-955-7199
Practice Address - Fax:414-955-0110
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI29706208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000176NOtherHUMANA
WI1467404970Medicaid
E60572Medicare UPIN
WI063B 73601Medicare PIN
002000176NOtherHUMANA