Provider Demographics
NPI:1316972953
Name:BROMER, LIANE MARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:LIANE
Middle Name:MARISSA
Last Name:BROMER
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 1:2100 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3139
Mailing Address - Country:US
Mailing Address - Phone:612-664-1151
Mailing Address - Fax:
Practice Address - Street 1:4021 S 700 E STE 300
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2184
Practice Address - Country:US
Practice Address - Phone:800-453-3030
Practice Address - Fax:800-328-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine