Jennifer A Brake
Family Doctor Family Doctor - Sports Medicine
111 W Jefferson Blvd Ste 100
South Bend
, Indiana 46601-1994
Jennifer A Brake
Family Doctor Family Doctor - Sports Medicine
111 W Jefferson Blvd Ste 100
South Bend
, Indiana 46601-1994
(574) 647-1610
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About
Features
Specialties
- Family Doctor
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Jennifer A Brake
- 710 N Niles Ave
- South Bend, IN
- Zip : 46617-1924
- Phone : (574) 647-1610
Second Address
- Jennifer A Brake
- 111 W Jefferson Blvd Ste 100
- South Bend, IN
- Zip : 46601-1994
- Fax : (574) 239-6461
- Phone : (574) 647-1669
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207Q00000X | Family Doctor | 01058572A | IN |
| Y | 207QS0010X | Family Doctor - Sports Medicine | 01058572A | IN |
National Provider Identifier
| NPI | 1093726713 |
|---|---|
| Provider Name | Jennifer A Brake |
| First Address | South Bend, IN 46617-1924 |
| Second Address | South Bend, IN 46601-1994 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/08/2006 |
| Last Update Date | 04/03/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000914879 | BCBS BMG SPORTS MEDICINE (01) | IN |
| 000000914885 | BCBS BMG E. BLAIR WARNER (01) | IN |
| 200475200 | (05) | IN |
| I11404 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.