| Doctor Name: | MELISSA A BROEDERS |
| NPI Number: | 1083618425 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C |
| License Number: | 5601004115 |
| Business Practice Address: | 1414 W Fair Ave Ste 201 Marquette, MI - 498555406 |
| Business Phone Number: | 9062254500 |
| Business Fax Number: | 9062253919 |
| Mailing Address: | N8149 W Fence River Rd, REPUBLIC |
| State: | MI |
| Postal Code: | 49879 |
| Phone Number: | 9063762013 |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601004115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |