Individual
WILLIAM N BRODINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 NE RALPH POWELL RD, LEES SUMMIT, MO 64064-2301
(816) 525-1600
Mailing address
PO BOX 872332, KANSAS CITY, MO 64187-2332
(816) 525-1600
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
0419969
KS
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
R3E15
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004626639
AETNA PPO
—
01
—
060013888
MEDICARE RAILROAD
—
01
—
10071014
PHP FREEDOM
—
05
—
1215981691
—
MO
01
—
431092652 A020
CHAMPUS TRICARE
—
Enumeration date
05/20/2006
Last updated
04/01/2015
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