Provider Demographics
NPI:1558352286
Name:BRAGMAN, JAMES B (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:BRAGMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6014 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2212
Mailing Address - Country:US
Mailing Address - Phone:248-855-7453
Mailing Address - Fax:248-855-7458
Practice Address - Street 1:6014 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2212
Practice Address - Country:US
Practice Address - Phone:248-855-7453
Practice Address - Fax:248-855-7458
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4989Medicare PIN
MION11810Medicare PIN
D72660Medicare UPIN