Provider Demographics
NPI:1598814071
Name:BRATTON CLINIC PC
Entity Type:Organization
Organization Name:BRATTON CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DIX
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:989-426-3689
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-0685
Mailing Address - Country:US
Mailing Address - Phone:989-426-3689
Mailing Address - Fax:989-426-3694
Practice Address - Street 1:1277 E CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-7004
Practice Address - Country:US
Practice Address - Phone:989-426-3689
Practice Address - Fax:989-426-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114726246Medicaid
MI0152616155OtherBLUE CROSS BLUE SHIELD
MIE26548Medicare UPIN
MI0P15500Medicare PIN