Provider Demographics
NPI:1982772752
Name:ROBERT K. BRATEMAN, MD,PC
Entity Type:Organization
Organization Name:ROBERT K. BRATEMAN, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BRATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-473-8580
Mailing Address - Street 1:40015 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2160
Mailing Address - Country:US
Mailing Address - Phone:248-473-8580
Mailing Address - Fax:248-474-4208
Practice Address - Street 1:40015 GRAND RIVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2160
Practice Address - Country:US
Practice Address - Phone:248-473-8580
Practice Address - Fax:248-474-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty