MEDICARE: MR. DANIEL J BROESKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11246	NV

General Provider Information

NPI Number	:	1013901750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL J BROESKE M.D.

Provider Business Mailing Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	STE 408
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2307
Country	:	US
Telephone Number	:	702-733-8018
Fax Number	:	702-733-8751

Provider Business Practice Location Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	STE 408
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2307
Country	:	US
Telephone Number	:	702-733-8018
Fax Number	:	702-733-8751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	12/07/2009

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