| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KEVIN A BROKAW | 1487714531 | 2024-07-05 |
Kevin A Brokaw PA [M] graduated in 2004 and primarily specializes in Physician Assistant.
Kevin A Brokaw is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1487714531. Registration indicates Kevin A Brokaw is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 9436115763 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Kevin A Brokaw PA-C |
| Practice Office Address | 1105 SIXTH ST TRAVERSE CITY, MI US |
| Practice Office Telephone | 2319357514 |
| Practice Office Fax | 2313920039 |
| Mailing Address | 1105 SIXTH ST TRAVERSE CITY, MI 496842345 US |
| Business Telephone | 2319357514 |
| Business Fax | 2313920039 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 3074 N US 31 S | Traverse City, MI 496844533 | 2319291234 / 2319291234 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | 5601004361
MI |