Individual
DR. EMMETT J. BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3900 KRESGE WAY, SUITE 45, LOUISVILLE, KY 40207-4660
(502) 894-4418
(502) 894-8966
Mailing address
3900 KRESGE WAY, SUITE 45, LOUISVILLE, KY 40207-4660
(502) 894-4418
(502) 894-8966
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
26593
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000227076
ANTHEM BLUE CROSS
KY
01
—
110239071
RAILROAD MEDICARE
KY
01
—
1167181
PASSPORT
KY
05
—
64265937
—
KY
Enumeration date
03/16/2006
Last updated
06/17/2010
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