Provider Demographics
NPI:1194785360
Name:BRASKO, MICHAEL J (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:BRASKO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 PIONEER PASS
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-8928
Mailing Address - Country:US
Mailing Address - Phone:419-706-4150
Mailing Address - Fax:
Practice Address - Street 1:1171 PIONEER PASS
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-8928
Practice Address - Country:US
Practice Address - Phone:419-706-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN142586367500000X
OHRN266011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773962Medicaid
OH0773962Medicaid