Active NPI
Kyle Braulick
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Big Lake, MN
National Provider Identifier
1932502267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2000003555
- Practice address
- 5025 Edinburgh Way
Big Lake, MN 55309-8271 - Phone
- (507) 276-6102
- NPI assigned
- Oct 1, 2014
- Last updated
- Oct 1, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2000003555 | MN | Primary |
Addresses
Primary practice location
5025 Edinburgh Way
Big Lake, MN 55309-8271
Mailing address
5025 Edinburgh Way
Big Lake, MN 55309-8271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000003555 | MN | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412121600000",
"number": "1932502267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5025 EDINBURGH WAY",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553098271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5025 EDINBURGH WAY",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553098271",
"telephone_number": "507-276-6102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAULICK",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-01",
"last_updated": "2014-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "MN",
"license": "2000003555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.