Provider Demographics
NPI:1669650560
Name:MICHAEL BROSMAN M.D., LLC
Entity Type:Organization
Organization Name:MICHAEL BROSMAN M.D., LLC
Other - Org Name:BROSMAN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-652-4650
Mailing Address - Street 1:104 PAIRED OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2169
Mailing Address - Country:US
Mailing Address - Phone:302-652-4650
Mailing Address - Fax:
Practice Address - Street 1:4514 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5118
Practice Address - Country:US
Practice Address - Phone:302-998-0484
Practice Address - Fax:302-656-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007995207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty