Provider Demographics
NPI:1619203874
Name:ROXANE S. BREMEN, D.O., P.C.
Entity Type:Organization
Organization Name:ROXANE S. BREMEN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-398-7048
Mailing Address - Street 1:622 SW 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2280
Mailing Address - Country:US
Mailing Address - Phone:816-398-7048
Mailing Address - Fax:913-562-9972
Practice Address - Street 1:622 SW 3RD ST
Practice Address - Street 2:STE B
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2280
Practice Address - Country:US
Practice Address - Phone:816-398-7048
Practice Address - Fax:913-562-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1050582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty