Provider Demographics
NPI:1205824869
Name:BROSCHART, REBECCA (DO)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BROSCHART
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 1:5671 N SKEEL AVE
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1535
Mailing Address - Country:US
Mailing Address - Phone:989-739-2550
Mailing Address - Fax:
Practice Address - Street 1:208 S STATE ST
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1642
Practice Address - Country:US
Practice Address - Phone:989-739-2550
Practice Address - Fax:989-358-3750
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH90159Medicare UPIN
GA08BBQTWMedicare ID - Type Unspecified