| Michael R. Brancheau M.d., Pllc | |
|
9330 Poppy Dr Ste 503 Dallas TX 75218-4696 | |
| (214) 321-3394 | |
| (214) 321-3469 |
| Full Name | Michael R. Brancheau M.d., Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9330 Poppy Dr Ste 503, Dallas, Texas |
| Authorized Official Name and Position | Michael Raymond Brancheau (OWNER) |
| Authorized Official Contact | 2143213394 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael R. Brancheau M.d., Pllc 9330 Poppy Dr Ste 503 Dallas TX 75218-4696 Ph: (214) 321-3394 | Michael R. Brancheau M.d., Pllc 9330 Poppy Dr Ste 503 Dallas TX 75218-4696 Ph: (214) 321-3394 |
| NPI Number | 1326423542 |
|---|---|
| Provider Enumeration Date | 07/29/2015 |
| Last Update Date | 01/11/2017 |
| Medicare PECOS PAC ID | 3779899059 |
|---|---|
| Medicare Enrollment ID | O20150901002131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326423542 | NPI | - | NPPES |
| 45D2110775 | Other | CLIA WAIVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K2854 (Texas) | Primary |
| Provider Name | Michael R Brancheau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134288012 PECOS PAC ID: 6800928623 Enrollment ID: I20100714000691 |
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