Provider Demographics
NPI:1659411619
Name:BRAUSA, BRIAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:BRAUSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LAKE ST
Mailing Address - Street 2:P.O. BOX 949
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-7663
Mailing Address - Country:US
Mailing Address - Phone:989-275-3668
Mailing Address - Fax:
Practice Address - Street 1:408 LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-275-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4857210430OtherBCBS PIN #
MIBB002144OtherBCBS LICENSE #
MI5198720Medicaid
MI5198720Medicaid
MIV12039Medicare UPIN