Provider Demographics
NPI:1124095278
Name:MOYER-BRAILEAN, TODD A (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:MOYER-BRAILEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:STE A109B
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-355-4205
Mailing Address - Fax:517-355-4202
Practice Address - Street 1:4660 S HAGADORN RD STE 210
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5353
Practice Address - Country:US
Practice Address - Phone:517-355-4205
Practice Address - Fax:517-364-8119
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009519207VF0040X
MITM009519207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
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MI1011190OtherMCLAREN PROVIDER #