Provider Demographics
NPI:1821014036
Name:BROGUNIER, MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BROGUNIER
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 1:99 HAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1202
Mailing Address - Country:US
Mailing Address - Phone:608-229-1580
Mailing Address - Fax:608-229-1580
Practice Address - Street 1:99 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1202
Practice Address - Country:US
Practice Address - Phone:608-229-1580
Practice Address - Fax:608-229-1580
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG94099Medicare UPIN
WI32567900Medicaid