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NPI Code Detail

MEDICARE: BENJAMIN BROGHAMMER M.D.

MEDICARE: BENJAMIN BROGHAMMER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician30364WI

General Provider Information

NPI Number : 1154303824
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN BROGHAMMER M.D.
Provider Business Mailing Address
First Line : 10945 N PORT WASHINGTON RD STE 201
Second Line :
City : MEQUON
State : WI
Zip : 53092-5078
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10945 N PORT WASHINGTON RD STE 201
Second Line :
City : MEQUON
State : WI
Zip : 53092-5078
Country : US
Telephone Number : 414-434-0461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 11/17/2023

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