Provider Demographics
NPI:1164482295
Name:BRODD, ANDERS J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDERS
Middle Name:J
Last Name:BRODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4856
Mailing Address - Country:US
Mailing Address - Phone:309-797-5437
Mailing Address - Fax:309-797-3140
Practice Address - Street 1:1625 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4856
Practice Address - Country:US
Practice Address - Phone:309-797-5437
Practice Address - Fax:309-797-3140
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics