Provider Demographics
NPI:1245266279
Name:BROOKS, KATHLEEN DWYER (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:DWYER
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Mailing Address - Street 2:1020 WEST BROADWAY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411
Mailing Address - Country:US
Mailing Address - Phone:612-302-8200
Mailing Address - Fax:612-302-8275
Practice Address - Street 1:UMPHYSICIANS BROADWAY FAMILY MEDICINE
Practice Address - Street 2:1020 WEST BROADWAY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MN26201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0144245Medicaid
MN0549006OtherPREFERRED ONE
MN21592OtherARAZ
MN01-20983OtherMEDICA CHOICE
MN109315OtherUCARE
MNHP31006OtherHEALTHPARTNERS
MN251P1BROtherBCBS
WI34065600Medicaid
IA0592204Medicaid
MN511K0BROtherBCBS BFM
MNA070OtherCHAMPUS
MN01-12519OtherMEDICA PRIMARY
MN01-21776OtherMEDICA CHOICE&PRIM BFM
WI34065600Medicaid