Provider Demographics
NPI:1215981691
Name:BRODINE, WILLIAM N (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:BRODINE
Suffix:
Gender:M
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:PO BOX 872332
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-2332
Mailing Address - Country:US
Mailing Address - Phone:816-525-1600
Mailing Address - Fax:
Practice Address - Street 1:3200 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2301
Practice Address - Country:US
Practice Address - Phone:816-525-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3E15207RC0001X
KS0419969207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10071014OtherPHP FREEDOM
431092652 A020OtherCHAMPUS TRICARE
10071014OtherBLUE SHIELD OF KC PPO
MO1215981691Medicaid
10071014OtherBLUE SHIELD OF KC HMO
0004626639OtherAETNA PPO
060013888OtherMEDICARE RAILROAD
0004626639OtherAETNA
0004626639OtherAETNA HMO
0004626639OtherAETNA
431092652 A020OtherCHAMPUS TRICARE
MOMA3395004Medicare PIN
MO4546121AMedicare ID - Type Unspecified