Provider Demographics
NPI:1922096551
Name:BRANCH, STEVEN K (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:BRANCH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MAPLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9352
Mailing Address - Country:US
Mailing Address - Phone:989-984-3788
Mailing Address - Fax:989-984-3794
Practice Address - Street 1:100 HOSPITAL LN STE 120
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1993
Practice Address - Country:US
Practice Address - Phone:317-745-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2092760Medicaid
MA2092760Medicaid
I22908Medicare UPIN