OrganizationActive
Broad Street Professional Medical Services LLC
NPI 1720630650 · Vascular Surgery Physician · Philadelphia, PA
Provider details
- NPI number
- 1720630650
- Entity type
- Organization
- Primary specialty
- Vascular Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Ami Almeda, Credentialing Manager(224) 318-0118
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2033 S Broad St Ste a
Philadelphia, PA 19148-5505
Phone: (215) 795-3855
Fax: (224) 235-4652
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 302
Northbrook, IL 60065-0302
Registry dates
- Enumerated
- 2019-07-11
- Last updated
- 2019-07-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.