Provider Demographics
NPI:1538320114
Name:WALTER E BRACKELMANNS MD INC
Entity Type:Organization
Organization Name:WALTER E BRACKELMANNS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRACKELMANNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-1225
Mailing Address - Street 1:14419 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1713
Mailing Address - Country:US
Mailing Address - Phone:818-990-1225
Mailing Address - Fax:818-990-7070
Practice Address - Street 1:14419 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1713
Practice Address - Country:US
Practice Address - Phone:818-990-1225
Practice Address - Fax:818-990-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6575251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health