Provider Demographics
NPI:1548224769
Name:BRATEMAN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BRATEMAN
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 1:40015 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2160
Mailing Address - Country:US
Mailing Address - Phone:248-473-8580
Mailing Address - Fax:248-474-4208
Practice Address - Street 1:40015 GRAND RIVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2160
Practice Address - Country:US
Practice Address - Phone:248-473-8580
Practice Address - Fax:248-474-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF37239001Medicare ID - Type Unspecified
D72580Medicare UPIN