Provider Demographics
NPI:1720032832
Name:BROSMAN, MICHAEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:BROSMAN
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 1:104 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 1:213 GREENHILL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-655-3321
Practice Address - Fax:302-656-8591
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232178-1207W00000X
DEC1-0007995207W00000X
PAMD 064397L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G88444Medicare UPIN