MEDICARE: KEVIN N BRAKE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.01275	OH
2	367500000X	Certified Registered Nurse Anesthetist	RN238227	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000185750	OTHER		ANTHEM

General Provider Information

NPI Number	:	1003867615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN N BRAKE CRNA

Provider Business Mailing Address
First Line	:	2215 E WATERLOO RD STE 313
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-3856
Country	:	US
Telephone Number	:	330-208-2720
Fax Number	:	330-208-2721

Provider Business Practice Location Address
First Line	:	2215 E WATERLOO RD
Second Line	:	STE 313
City	:	AKRON
State	:	OH
Zip	:	44312-3856
Country	:	US
Telephone Number	:	330-208-2720
Fax Number	:	330-208-2721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/09/2026

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