Provider Demographics
NPI:1215486733
Name:BRAUN, ANGELA CAROL (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROL
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 GROVE PARK RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1443
Mailing Address - Country:US
Mailing Address - Phone:248-877-2436
Mailing Address - Fax:
Practice Address - Street 1:2500 PACKARD ST STE 104A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6827
Practice Address - Country:US
Practice Address - Phone:248-877-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant