Provider Demographics
NPI:1558302794
Name:BRAFF, STEVEN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:BRAFF
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 1:5400 KENNEDY AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2664
Mailing Address - Country:US
Mailing Address - Phone:513-281-3400
Mailing Address - Fax:
Practice Address - Street 1:5400 KENNEDY AVE
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2664
Practice Address - Country:US
Practice Address - Phone:513-281-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-21632085R0202X
IN01075026A2085R0202X
VT042-000085842085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201278670Medicaid
NY10475535OtherCAQH
MI1558302794Medicaid
OH2311733Medicaid
NY00536030Medicaid
IN981270007Medicare PIN
MI1558302794Medicaid
NVV11043Medicare PIN
NYB74784Medicare UPIN