Provider Demographics
NPI:1245284595
Name:BROUSSEAU, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BROUSSEAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC EMERGENCY MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2625
Mailing Address - Fax:414-266-2635
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC EMERGENCY MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2625
Practice Address - Fax:414-266-2635
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI382802080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002006261GOtherHUMANA
WI1245284595Medicaid
WI736011727Medicare PIN
002006261GOtherHUMANA