Provider Demographics
NPI:1649530510
Name:BREWER, TAKAE MIZUKAMI (MD)
Entity type:Individual
Prefix:
First Name:TAKAE
Middle Name:MIZUKAMI
Last Name:BREWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5203 MCANANY DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1528
Mailing Address - Country:US
Mailing Address - Phone:913-588-7750
Mailing Address - Fax:913-588-8766
Practice Address - Street 1:2650 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2003
Practice Address - Country:US
Practice Address - Phone:913-588-7750
Practice Address - Fax:913-588-8766
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN17303207R00000X
KS04-37946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine