Provider Demographics
NPI:1942221627
Name:BRAKARSH, DANIEL (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BRAKARSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3463
Mailing Address - Country:US
Mailing Address - Phone:608-237-8000
Mailing Address - Fax:608-237-8005
Practice Address - Street 1:6300 UNIVERSITY AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3463
Practice Address - Country:US
Practice Address - Phone:608-237-8000
Practice Address - Fax:608-237-8005
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI911-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39116900Medicaid
1011070OtherPHYSICIANS PLUS INSURANCE