Provider Demographics
NPI:1982234126
Name:BRAUTIGAM, JOSEPH (CNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BRAUTIGAM
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5901
Mailing Address - Country:US
Mailing Address - Phone:419-228-8950
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 350
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025833208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty