Individual
BRATON FREDLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012396
MI
363A00000X
Physician Assistant
PA190887
OR
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/29/2016
Last updated
04/29/2024
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