Individual
DR. JAMIE C BROEKHUIZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004512A
IN
207Q00000X
Family Medicine Physician
036129571
IL
207Q00000X
Family Medicine Physician
5101016722
MI
390200000X
Student in an Organized Health Care Education/Training Program
5101016722
MI
Other
Enumeration date
06/06/2007
Last updated
10/03/2022
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