Broadbent, Wallace
Broadbent, Wallace is an individual health care provider with primary practice located at 1535 Gull Rd Msb 015, Kalamazoo MI 49048-1650. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Broadbent, Wallace can be contacted via phone (269) 226-6933.Contact Information
Primary practice address
1535 Gull Rd Msb 015
Kalamazoo MI 49048-1650
Phone: (269) 226-6933
Fax: (269) 226-6949
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 5101011784 | Michigan |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 5101011784 | Michigan |
Profile Details
| NPI number | 1861443202 |
|---|---|
| LBN Legal business name | Broadbent, Wallace |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Feb 10th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861443202 | NPPES |
| Michigan | Other | 3123256-11 | MEDICAID - THREE RIVERS |
| Michigan | Other | 700G560080 | MEDICAID - THREE RIVERS |
| Michigan | Other | WB011784 | MEDICAID - THREE RIVERS |
| Michigan | MEDICAID | 114572856 | MEDICAID - THREE RIVERS |
Popular Providers
-
Kiser, Robert C
2520 Robert Jones Way , Kalamazoo MI 49009-1904 -
Doster, Millard
1535 Gull Rd Msb 015, Kalamazoo MI 49048-1650 -
Keithley, Joseph Keller
601 John St Bronson Hospital Emergency Department, Kalamazoo MI 49007 -
Armstrong, Beth Joy
1850 Whites Rd Suite 3, Kalamazoo MI 49008-4801 -
Fuertes, Jose
1535 Gull Rd Msb 015, Kalamazoo MI 49048-1650 -
Rehkopf, Paul
1917 Argyle Ave , Kalamazoo MI 49008-2213 -
Forrest, Lisa Wagner
1850 Whites Rd , Kalamazoo MI 49008-4801 -
Kothari, Rashmikant
1535 Gull Rd Msb 015, Kalamazoo MI 49048-1650