MEDICARE: BROCKMAN SCHUMACHER JR. L.P.

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
1	103T00000X	Psychologist	LP0641	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	718549900	OTHER	MN	MN HEALTH CARE PROGRAMS

General Provider Information

NPI Number	:	1508932278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCKMAN SCHUMACHER JR. L.P.

Provider Business Mailing Address
First Line	:	240 PARK AVE UNIT 600
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-2254
Country	:	US
Telephone Number	:	612-232-0567
Fax Number	:	612-584-3915

Provider Business Practice Location Address
First Line	:	1516 W LAKE ST STE 350C
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2554
Country	:	US
Telephone Number	:	612-232-0567
Fax Number	:	612-584-3915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	06/11/2025

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