Organization
BROAD STREET MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMI ALMEDA (CREDENTIALING MANAGER)
(224) 318-0118
Entity
Organization
Contact information
Practice address
2033 S BROAD ST STE B, PHILADELPHIA, PA 19148-5505
(215) 809-1447
(224) 235-4652
Mailing address
PO BOX 302, NORTHBROOK, IL 60065-0302
(847) 593-8460
(224) 235-4652
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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