Michael D Broadwell, PSY.D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP6869 Issued in MN

Practice address

3535 40TH Ave NW Ste 210
Rochester, MN 55901-1769

Phone

(507) 516-0227

Fax

(507) 516-0228

NPI assigned

Sep 22, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1053645119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 40TH AVE NW STE 210",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011769",
            "telephone_number": "507-516-0227",
            "fax_number": "507-516-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 40TH AVE NW STE 210",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011769",
            "telephone_number": "507-516-0227",
            "fax_number": "507-516-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-22",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Pablo Brito Campana, M.D
• Brittni J. Timmerman, LLC
• Jeffrey W. Britton, M.D.
• Hajrudina Brkic, NP
• Autumn Rose Broadwater
• Adam David Brockway, MD
• Michael H Broderdorf, MD
• Brian William Brodersen, D.D.S.
• Wendy J Brodhagen, PA
• Michelle L Brodin, PHARMD

• Psychologist in Rochester, MN
• Providers in Rochester, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.