Provider Demographics
NPI:1518053818
Name:BRODBECK, SUZANNE FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:FRANCES
Last Name:BRODBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1000
Mailing Address - Country:US
Mailing Address - Phone:419-841-7701
Mailing Address - Fax:419-255-4037
Practice Address - Street 1:6605 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1000
Practice Address - Country:US
Practice Address - Phone:419-841-7701
Practice Address - Fax:419-255-4037
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0820242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI12472Medicare UPIN