Healthcare Provider Details

I. General information

NPI: 1205824869
Provider Name (Legal Business Name): REBECCA BROSCHART D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S STATE ST
OSCODA MI
48750-1642
US

IV. Provider business mailing address

5671 N SKEEL AVE
OSCODA MI
48750-1535
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-2550
  • Fax: 989-358-3750
Mailing address:
  • Phone: 989-739-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053105
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: