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NPI Code Detail

MEDICARE: BAYLEE MARIE BROEHM PA-C

MEDICARE: BAYLEE MARIE BROEHM PA-C
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
1363A00000XPhysician Assistant7564WI

General Provider Information

NPI Number : 1477235224
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAYLEE MARIE BROEHM PA-C
Provider Business Mailing Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-805-6400
Fax Number : 414-955-0213
Provider Business Practice Location Address
First Line : 9000 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-4874
Country : US
Telephone Number : 414-943-1165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2023
Last Update Date : 12/18/2025

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Directions to “ BAYLEE MARIE BROEHM PA-C” Practice Location

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