Active NPI
Kevin Broder, MD
- Internal Medicine Physician
- Minneapolis, MN
National Provider Identifier
1528247855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 49934
- Practice address
- 420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341 - Phone
- (612) 626-5031
- NPI assigned
- Nov 2, 2007
- Last updated
- Nov 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 49934 | MN | Primary |
Addresses
Primary practice location
420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341
Mailing address
420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341
Phone (612) 626-5031
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49934 | MN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193961600000",
"number": "1528247855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"address_2": "MMC 284",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "612-626-5031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"address_2": "MMC 284",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "612-626-5031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODER",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-02",
"last_updated": "2007-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "49934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.