Individual
MICHAEL SCOTT BROAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1555 SOUTH BLVD E, SUITE 310, ROCHESTER HILLS, MI 48307-5605
(248) 215-8095
(248) 289-1086
Mailing address
1635 FAIRHOLME RD, GROSSE POINTE WOODS, MI 48236-2368
(313) 882-5473
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601003846
MI
Other
Enumeration date
06/06/2006
Last updated
11/06/2012
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