Provider Demographics
NPI:1710957428
Name:BROMBERG, ISAAC M (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:M
Last Name:BROMBERG
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 1:310 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3199
Mailing Address - Country:US
Mailing Address - Phone:406-752-5111
Mailing Address - Fax:
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3199
Practice Address - Country:US
Practice Address - Phone:406-752-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223813207PH0002X
MT94397207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1710957428Medicaid
MAA38797Medicare ID - Type Unspecified
MA2106345Medicaid
MA223813OtherCONNECTICARE
MAJ29319OtherBLUE CROSS AND BLUE SHIEL
MA26369OtherHEALTH NEW ENGLAND
MA4167567OtherCIGNA
MA000000030952OtherBMC HEALTHNET
MA468486OtherTUFTS HEALTH PLAN
MA89493OtherCHILDREN'S MEDICAL SECURI
MD3956037OtherAETNA
MAI34975Medicare UPIN