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NPI Code Detail

MEDICARE: MICHAEL A BRODZELLER B.S.

MEDICARE: MICHAEL A BRODZELLER B.S.
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
1225100000XPhysical Therapist1252WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27742485OTHERWIAETNA

General Provider Information

NPI Number : 1194720789
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL A BRODZELLER B.S.
Provider Business Mailing Address
First Line : 5595 COUNTY ROAD Z
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9224
Country : US
Telephone Number : 262-306-2150
Fax Number : 262-306-2151
Provider Business Practice Location Address
First Line : 5595 COUNTY ROAD Z
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9224
Country : US
Telephone Number : 262-306-2150
Fax Number : 262-306-2151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 11/03/2008

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