Active NPI
Michelle Broberg II, MA
- Technician
- Lakewood, CO
National Provider Identifier
1619365533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician
- License
- B6J5Y9K5
- Practice address
- 12055 West 2ND Plaza
Lakewood, CO 80228 - Phone
- (303) 425-0300
- NPI assigned
- Dec 30, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Technician | 374700000X | B6J5Y9K5 | CO | Primary |
Addresses
Primary practice location
12055 West 2ND Plaza
Lakewood, CO 80228
Mailing address
3805 W. 26TH Ave
Denver, CO 80211
Phone (720) 878-2923
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B6J5Y9K5 | CO | MD | Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419897600000",
"number": "1619365533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3805 W. 26TH AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "80211",
"telephone_number": "720-878-2923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12055 WEST 2ND PLAZA",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "80228",
"telephone_number": "303-425-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROBERG",
"first_name": "MICHELLE",
"name_suffix": "II",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-30",
"last_updated": "2014-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "374700000X",
"taxonomy_group": "",
"desc": "Technician",
"state": "CO",
"license": "B6J5Y9K5",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.