DR. JOHN W. BROVIAC M.D. NPI 1124070479

NPI Information

NPI: 1124070479
Provider Name: DR. JOHN W. BROVIAC, M.D.
Classification: Internal Medicine - 207RN0300X
Entity Type: Individual

Specialization: Nephrology

PECOS Registration: Yes

Address:
2601 COOLIDGE RD
STE B
EAST LANSING, MI
ZIP 48823
Phone: (517) 913-4050
Get Directions

DR. John W. Broviac, M.D. is a nephrology internal medicine in East Lansing, MI. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. DR. John W. Broviac, M.D. NPI is 1124070479. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2601 COOLIDGE RD
STE B
EAST LANSING, MI
ZIP 48823-361
Phone: (517) 913-4050
Fax: (517) 333-0893

The NPI 1124070479 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/16/2006 and was last updated on 1/13/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RN0300X	Internal Medicine	Nephrology	4301034184	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1103351181	OTHER	MICHIGAN	BCBS/BCN
2	5151077	OTHER	MICHIGAN	AETNA
3	200000001388	OTHER	MICHIGAN	PHP FAMILYCARE
4	3421169	MEDICAID	MICHIGAN
5	200000001388	OTHER	MICHIGAN	PHP
6	194055	OTHER	MICHIGAN	PHCS
7	B46099	MEDICARE UPIN	MICHIGAN
8	M54760003	MEDICARE PIN	MICHIGAN
9	1001247	OTHER	MICHIGAN	MCLAREN HEALTH PLAN-MEDICAID
10	3421187	MEDICAID	MICHIGAN
11	0M54760003	OTHER	MICHIGAN	MEDICARE PLUS BLUE
12	1001247	OTHER	MICHIGAN	MCLAREN HEALTH ADVANTAGE
13	1001247	OTHER	MICHIGAN	MCLAREN HEALTH PLAN-COMMERCIAL
14	110159644	OTHER	MICHIGAN	RAILROAD MEDICARE
15	M54770003	MEDICARE PIN	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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