Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | C154366 | IA |
NPI | 1154913390 |
---|---|
Provider Name | Michael Andrew Brooks |
First Address | Urbandale, IA 50322-1172 |
Second Address | Des Moines, IA 50309-1413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 10/02/2021 |