Provider Demographics
NPI:1548296619
Name:BRAMAN, JONATHAN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PATRICK
Last Name:BRAMAN
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 FORD PL STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-874-4806
Mailing Address - Fax:313-876-1305
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2181
Practice Address - Fax:313-876-1305
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508983207X00000X, 207XX0005X
MN47859207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN135158OtherUCARE
IA0598524Medicaid
MN924420400Medicaid
MT0147917Medicaid
MNE017OtherCHAMPUS
MN2378187OtherARAZ
MN09-00027OtherMEDICA PRIMARY
MN09-02166OtherMEDICA CHOICE
MNHP54584OtherHEALTHPARTNERS
MT0147917Medicaid
MNE017OtherCHAMPUS
MN09-02166OtherMEDICA CHOICE