Healthcare Provider Details

I. General information

NPI: 1073180824
Provider Name (Legal Business Name): ADAM M BROSIOUS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HOSPITAL DR STE 130
DUBLIN OH
43016-9600
US

IV. Provider business mailing address

251 MONARCH DR
PATASKALA OH
43062-8922
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0300
  • Fax:
Mailing address:
  • Phone: 740-513-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0028756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: