Individual
ANDREW D BROADMOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
46673
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0495960
—
IA
01
—
18118
MEDICARE GROUP NUMBER
IA
Enumeration date
04/04/2006
Last updated
02/20/2020
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