NPIMap

Individual provider Active NPI

Frederick F Broniak, DO

  • Emergency Medical Services (Emergency Medicine) Physician
  • Wyandotte, MI
National Provider Identifier
1164465621
Registry record updated Nov 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
008243 Issued in MI
Practice address
2333 Biddle St
Wyandotte, MI 48192-4668
Phone
(313) 284-9400
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 008243 MI Primary

Addresses

Primary practice location

2333 Biddle St
Wyandotte, MI 48192-4668

Mailing address

9360 Stonehouse Ave
Livonia, MI 48150-3454
Phone (248) 719-4012

Other identifiers 3

IdentifierTypeStateIssuer
4266852MedicaidMI
4832740MedicaidMI
FB008243OtherMIBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
008243MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Detroit Osteopathic Hospital Corporation Past Accepting new patients
Ohio Em-I Medical Services, Professional Association Past Accepting new patients
Mercy Emergency Care Services, Inc. Past Accepting new patients
Statcare PC Past Accepting new patients
Stat Care PC Emergency Medical Services Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: fbroniak59686@mymichiganhealth.midirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353542400000",
    "number": "1164465621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9360 STONEHOUSE AVE",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481503454",
            "telephone_number": "248-719-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 BIDDLE ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481924668",
            "telephone_number": "313-284-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONIAK",
        "first_name": "FREDERICK",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "008243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4266852",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4832740",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "FB008243",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2012; 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.