MEDICARE: JANE M BROTANEK 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	208000000X	Pediatrics Physician	47361	WI
2	208000000X	Pediatrics Physician	050206	CT

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	605885158003	OTHER	WI	BC/BS
4	7189387	OTHER	WI	AETNA

General Provider Information

NPI Number	:	1427053032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE M BROTANEK MD

Provider Business Mailing Address
First Line	:	38B GROVE STREET
Second Line	:	RIDGEFIELD PEDIATRIC ASSOCIATES
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877
Country	:	US
Telephone Number	:	203-438-9557
Fax Number	:	203-438-7857

Provider Business Practice Location Address
First Line	:	38B GROVE STREET
Second Line	:	RIDGEFIELD PEDIATRIC ASSOCIATES
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877
Country	:	US
Telephone Number	:	203-438-9557
Fax Number	:	203-438-7857

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/07/2023

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Directions to “ JANE M BROTANEK MD” Practice Location

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