Provider Demographics
NPI:1528094976
Name:BRAYTON, RENEE SUE (DO)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:SUE
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:4200 WHITEHALL DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:810-225-0086
Practice Address - Fax:810-225-0286
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-06-14
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Provider Licenses
StateLicense IDTaxonomies
MI5101012364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4748753Medicaid
MI0853302604OtherBCBS INDIVIDUAL PIN
MIG64293Medicare UPIN
MI4748753Medicaid