Individual
DR. PAUL EUGENE BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1215 HADLEY RD STE 206, MOORESVILLE, IN 46158-2905
(317) 834-1919
(317) 834-1920
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
02001623A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095924
ANTHEM
IN
05
—
200037350
—
IN
01
—
MEDICARE
M400061013
IN
Enumeration date
06/30/2005
Last updated
04/14/2023
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