Healthcare Provider Details

I. General information

NPI: 1427084029
Provider Name (Legal Business Name): BRIAN M BROTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PINE RIDGE BLVD SUITE 211
WAUSAU WI
54401-4123
US

IV. Provider business mailing address

425 PINE RIDGE BLVD SUITE 211
WAUSAU WI
54401-4123
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-5505
  • Fax: 715-848-2884
Mailing address:
  • Phone: 715-845-5505
  • Fax: 715-848-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34208020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: