Provider Demographics
NPI:1932275419
Name:BRANIGIN, TIMOTHY DALE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:BRANIGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8065
Mailing Address - Country:US
Mailing Address - Phone:810-606-5560
Mailing Address - Fax:
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046006207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI125406OtherCARE CHOICES
MI125406OtherPREFERRED CHOICES
MI1003981OtherMCLAREN HEALTH PLAN
MI565566OtherSELECTCARE
MI3515345OtherHEALTH PLAN OF MI
MI3515345OtherMOLINA HEALTHCARE
MI220021089OtherRAILROAD MEDICARE
MI3515345Medicaid
MI27214OtherCOMMUNITY CHOICE OF MI
MI125406OtherCARE CHOICES
MI220021089OtherRAILROAD MEDICARE