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General NPI Number Information
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NPI Number | 1538211537
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Entity Type | Organization
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Legal Business Name | JAMES A. BROSTROM
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1900 LAURA LN
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City | WAUKESHA
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State | WI
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Zip | 53186-2808
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Country | US
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Telephone | 262-896-9661
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Fax | 262-896-9662
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Provider Business Mailing Address
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Address Line | PO BOX 338
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City | WAUKESHA
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State | WI
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Zip | 53187-0338
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Country | US
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Telephone | 262-896-9661
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Fax | 262-896-9662
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES A BROSTROM
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Credential |
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Telephone | 262-896-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14650
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License Number State | WI
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