Provider Demographics
NPI:1154421642
Name:BROTTMAN, GAIL M (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:BROTTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS HCMC
Mailing Address - Street 2:701 PARK AVE S MAIL CODE G-7
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-0001
Mailing Address - Country:US
Mailing Address - Phone:612-873-2671
Mailing Address - Fax:612-904-4284
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:G7
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.0733872080P0214X
MN291062080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27078Medicare UPIN