Provider Demographics
NPI:1649246984
Name:BRANCH, MICHAEL ERWIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERWIN
Last Name:BRANCH
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7539
Mailing Address - Country:US
Mailing Address - Phone:813-778-0101
Mailing Address - Fax:813-377-1661
Practice Address - Street 1:38103 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542
Practice Address - Country:US
Practice Address - Phone:813-907-9992
Practice Address - Fax:813-355-5034
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.148214207Y00000X
FLME66400207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004602300Medicaid
FL004602300Medicaid
FL004602300Medicaid
FL32144VMedicare PIN
FL32144AMedicare ID - Type Unspecified