MEDICARE: CHRISTINE BROSZKO 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
1	207Q00000X	Family Medicine Physician	28742	NE
2	207Q00000X	Family Medicine Physician	7171	NE
3	207Q00000X	Family Medicine Physician	69360	MN

General Provider Information

NPI Number	:	1831502889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE BROSZKO M.D.

Provider Business Mailing Address
First Line	:	8170 33RD AVENUE S
Second Line	:	MAILSTOP 21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	576 APOLLO DR
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55014-3004
Country	:	US
Telephone Number	:	651-486-2320
Fax Number	:

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

Provider Enumeration Date	:	06/07/2014
Last Update Date	:	07/01/2022

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