Provider Demographics
NPI:1770558876
Name:BRAKER, J CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:CHRISTOPHER
Last Name:BRAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17100 W NORTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-784-3800
Mailing Address - Fax:262-784-7936
Practice Address - Street 1:2717 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-549-6649
Practice Address - Fax:262-784-7936
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2935020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30381500Medicaid
WI30381500Medicaid
WIBB1520077OtherDEA