Provider Demographics
NPI:1255345609
Name:BRODE, AMY LYNN-OPPERER (DO)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN-OPPERER
Last Name:BRODE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR.
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-712-8100
Mailing Address - Fax:734-712-8111
Practice Address - Street 1:4350 JACKSON RD STE 350
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-712-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014854208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB9133OtherRAILROAD MEDICARE
MI0E06273OtherBCBSM
MI114930080Medicaid
MICB9133OtherRAILROAD MEDICARE
MI114930080Medicaid
MI0425310004Medicare NSC
MI0425310002Medicare NSC
MI0E06273OtherBCBSM
MII61774Medicare UPIN