Provider Demographics
NPI:1043422777
Name:BROTSKY, DESIREE DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:DAWN
Last Name:BROTSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10967
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0967
Mailing Address - Country:US
Mailing Address - Phone:602-595-9696
Mailing Address - Fax:623-412-9123
Practice Address - Street 1:15396 N 83RD AVE
Practice Address - Street 2:STE F100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:602-595-9696
Practice Address - Fax:602-412-9123
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ632408Medicaid
AZZ147947Medicare PIN