MEDICARE: ALAIN F BROCCARD MD

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	207R00000X	Internal Medicine Physician	01075203A	IN
2	207R00000X	Internal Medicine Physician	39304	MN
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	277095	NY
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	39304	MN
5	207RP1001X	Pulmonary Disease Physician	39304	MN
6	207RP1001X	Pulmonary Disease Physician	01075203A	IN
7	207RP1001X	Pulmonary Disease Physician	277095	NY
8	207RS0012X	Sleep Medicine (Internal Medicine) Physician	277095	NY
9	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01075203A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164498739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAIN F BROCCARD MD

Provider Business Mailing Address
First Line	:	10933 HUMBOLDT AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55431-4221
Country	:	US
Telephone Number	:	612-638-7764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 UNIVERSITY AVE W FL 6
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:	651-232-2273
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	04/09/2018

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Directions to “ ALAIN F BROCCARD MD” Practice Location

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