Provider Demographics
NPI:1487656674
Name:BRAVERMAN, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1318
Mailing Address - Country:US
Mailing Address - Phone:913-491-9123
Mailing Address - Fax:913-491-6608
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-491-9123
Practice Address - Fax:913-491-6608
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417188207W00000X
MOR8108207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4001325OtherAETNA HEALTHCARE
06907178OtherBLUE CROSS BLUE SHIELD
KS180012951OtherRR MEDICARE
KS2050477501CMedicaid
MO200730638Medicaid
0809553OtherUNITED HEALTHCARE
2343355017OtherCIGNA
C50350Medicare UPIN
MO200730638Medicaid