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NPI Code Detail

MEDICARE: IAN BRODKA MD

MEDICARE: IAN BRODKA 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1538863394
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN BRODKA MD
Provider Business Mailing Address
First Line : 1500 E MEDICAL CENTER DR # TC-B1380
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-5000
Country : US
Telephone Number : 716-341-4241
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E MEDICAL CENTER DR # TC-B1380
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-5000
Country : US
Telephone Number : 716-341-4241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 03/28/2023

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