MEDICARE: NICHOLAS BROUGH

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1962228940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BROUGH

Provider Business Mailing Address
First Line	:	4000 WELLNESS DR
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48670-1000
Country	:	US
Telephone Number	:	844-832-1956
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 E PICKARD ST STE 2700
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2042
Country	:	US
Telephone Number	:	989-463-2333
Fax Number	:

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

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	06/10/2026

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Directions to “ NICHOLAS BROUGH ” Practice Location

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