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Dr. Wallace Broadbent, DO
General Practice Physician in Kalamazoo, Michigan
NPI 1861443202

Wallace Broadbent is a General Practice Physician based in Kalamazoo, MI. Wallace Broadbent practices in Kalamazoo, MI and has the professional credentials of DO. The NPI Number for Wallace Broadbent is 1861443202 and holds a License No. 5101011784 (Michigan).

The current practice location address for Wallace Broadbent is 1535 Gull Rd, Kalamazoo, MI and can be reached out via phone at 269-226-6933 and via fax at 269-226-6949.

Location: 1535 Gull Rd, Kalamazoo, MI, 49048-1650
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1861443202
Provider Name
Wallace Broadbent
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
1535 Gull Rd, Kalamazoo, MI, 49048-1650
Phone Number
269-226-6933
Fax Number
269-226-6949
Provider Enumeration Date
05/12/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3123256-11 01 MI MEDICAID - THREE RIVERS
700G560080 01 MI BCBS GROUP-THREE RIVERS HEALTH
WB011784 01 MI BLUE CROSS BLUE SHIELD
114572856 05 MI
institution
Provider Business Practice Location Address Details
Address
1535 Gull Rd
City
Kalamazoo
State
Michigan
Zip
49048-1650
Phone Number
269-226-6933
Fax Number
269-226-6949
person
Provider Business Mailing Address Details
Address
1535 Gull Rd
City
Kalamazoo
State
Michigan
Zip
49048-1650
Phone Number
269-226-6933
Fax Number
269-226-6949
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Emergency Medicine
Speciality
-
Taxonomy
207P00000X
License No.
5101011784 (Michigan)
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
5101011784 (Michigan)
Definition
Definition to come...
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