Provider Demographics
NPI:1043530520
Name:BRUBACHER, MARIE SUZY (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:SUZY
Last Name:BRUBACHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:SUZY
Other - Last Name:BEWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:KANSAS UNIVERSITY PHYSICIANS, INC.
Mailing Address - Street 2:3901 RAINBOW BLVD. 4070 DELP, MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2501
Mailing Address - Fax:913-588-6055
Practice Address - Street 1:DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY
Practice Address - Street 2:3901 RAINBOW BLVD. 6040 DELP, MS 1020
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty