Provider Demographics
NPI:1912490905
Name:BRADEN, MARK DAVID JR (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:BRADEN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1150 E SHERMAN BLVD STE 2400
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1886
Mailing Address - Country:US
Mailing Address - Phone:231-672-6336
Mailing Address - Fax:231-672-6335
Practice Address - Street 1:3300 EAGLE RUN DR NE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7069
Practice Address - Country:US
Practice Address - Phone:616-234-2830
Practice Address - Fax:616-234-2829
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101024138204D00000X
MI5101026336204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM