Provider Information for 1588605257
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Mr. RICHARD H BROACH APNP
Sex: Male
NPI: 1588605257
Last Updated: 2016-06-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1588605257 | ||||||||||||
| Enumeration Date | 2006-06-10 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 309 E NORTH ST WAUKESHA, WI 53188-3718 United States Phone: 414-672-1353 | Fax:414-385-7552 | ||||||||||||
| Primary Practice Address | 309 E NORTH ST WAUKESHA, WI 53188-3718 United States Phone: 414-672-1353 | Fax:414-385-7552 | ||||||||||||
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