Provider Demographics
NPI:1982647269
Name:BRODKEY, MARK J (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:BRODKEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6420 PROSPECT AVENUE
Mailing Address - Street 2:T417
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132
Mailing Address - Country:US
Mailing Address - Phone:816-333-2880
Mailing Address - Fax:816-333-2726
Practice Address - Street 1:6420 PROSPECT AVENUE
Practice Address - Street 2:T417
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-333-2880
Practice Address - Fax:816-333-2725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO57633208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1353655Medicare ID - Type Unspecified
C51022Medicare UPIN