Individual
DR. JOHN SCOTT BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13133 N PORT WASHINGTON RD, SUITE G06, MEQUON, WI 53097-2419
(262) 243-8371
(262) 243-8342
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLNIC CREDENTIALING, GLENDALE, WI 53212-1082
(262) 243-8371
(262) 243-8342
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
46762-020
WI
Other
Enumeration date
11/15/2006
Last updated
06/08/2012
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