Provider Demographics
NPI:1225155641
Name:BREWSTER, AMY H (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:H
Last Name:BREWSTER
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 1:425 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2526
Mailing Address - Country:US
Mailing Address - Phone:920-725-0700
Mailing Address - Fax:920-725-7978
Practice Address - Street 1:425 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2526
Practice Address - Country:US
Practice Address - Phone:920-725-0700
Practice Address - Fax:920-725-7978
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63142-0202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400193988OtherMEDICARE