Provider Demographics
NPI:1295833523
Name:TEN BROEKE, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:TEN BROEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3129
Mailing Address - Country:US
Mailing Address - Phone:508-778-1829
Mailing Address - Fax:508-778-0113
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3129
Practice Address - Country:US
Practice Address - Phone:508-778-1829
Practice Address - Fax:508-778-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA34466207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000030691OtherBOSTON MEDICAL CENTER
MA1295833523OtherUNICARE
MA1295833523OtherGREAT WEST HEALTHCARE
MA1295833523OtherNETWORK HEALTH
MA2272797OtherAETNA
MAS017060OtherTRICARE
MA060058508OtherMEDICARE ID
11090818OtherCAQH
MA3199OtherHARVARD PILGRIM
MA709254OtherTUFTS
MAE16121OtherBLUE CROSS BLUE SHIELD
MA1019191-001OtherCIGNA
MA25-00637OtherUNITED HEALTH
MA2060817Medicaid
MA2272797OtherAETNA
MA2060817Medicaid