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General NPI Number Information
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NPI Number | 1083970826
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE BRODERICK-FORSGREN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 234 GOODMAN ST
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City | CINCINNATI
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State | OH
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Zip | 45219-2364
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Country | US
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Telephone | 513-584-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 CELESTIAL ST
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City | CINCINNATI
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State | OH
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Zip | 45202-1609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35 125546
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License Number State | OH
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