Provider Demographics
NPI:1760460232
Name:BRAUNSTEIN, DAVID BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 PARK DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461
Mailing Address - Country:US
Mailing Address - Phone:708-748-9800
Mailing Address - Fax:708-748-9807
Practice Address - Street 1:24 JOLIET STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311
Practice Address - Country:US
Practice Address - Phone:219-865-0893
Practice Address - Fax:219-865-3599
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002225207RC0000X
IN02002225A207RC0000X
IL036-049891207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100363490AMedicaid
IN406090IMedicare PIN
IN406310NMedicare PIN
IND89288Medicare UPIN