Provider Demographics
NPI:1568591246
Name:MICHAEL BRADEN, MD, PA
Entity Type:Organization
Organization Name:MICHAEL BRADEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-992-9189
Mailing Address - Street 1:641 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013
Mailing Address - Country:US
Mailing Address - Phone:830-997-0854
Mailing Address - Fax:
Practice Address - Street 1:641 HIGH STREET
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013
Practice Address - Country:US
Practice Address - Phone:830-997-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0203207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151360801Medicaid
TX00071TMedicare PIN
TX151360801Medicaid