Provider Demographics
NPI:1831502889
Name:BROSZKO, CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BROSZKO
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 1:8170 33RD AVENUE S
Mailing Address - Street 2:MAILSTOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:576 APOLLO DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-3004
Practice Address - Country:US
Practice Address - Phone:651-486-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28742207Q00000X
NE7171207Q00000X
MN69360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine