Provider Demographics
NPI:1922037241
Name:BROOKS, JOANNE RENELLE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:RENELLE
Last Name:BROOKS
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 1:2085 N CALHOUN RD
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5003
Mailing Address - Country:US
Mailing Address - Phone:262-928-7100
Mailing Address - Fax:
Practice Address - Street 1:2085 N CALHOUN RD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5003
Practice Address - Country:US
Practice Address - Phone:262-928-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40312-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34660900Medicaid
G82868Medicare UPIN
68375Medicare PIN