Healthcare Provider Details

I. General information

NPI: 1164498739
Provider Name (Legal Business Name): ALAIN F BROCCARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

10933 HUMBOLDT AVE S
MINNEAPOLIS MN
55431-4221
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2273
  • Fax:
Mailing address:
  • Phone: 612-638-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01075203A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39304
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number277095
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number39304
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number39304
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01075203A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number277095
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number277095
License Number StateNY
# 9
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01075203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: