Individual
MUSTAFA BROACHWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 ORLEANS ST, BALTIMORE, MD 21287-0010
(410) 955-5000
Mailing address
3249 OAK PARK AVE, BERWYN, IL 60402-0715
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
125076506
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2020
Last updated
06/21/2021
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