Healthcare Provider Details

I. General information

NPI: 1427215128
Provider Name (Legal Business Name): JASON ANDREW BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/07/2023
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 45TH AVE SUITE 101
MUNSTER IN
46321-2938
US

IV. Provider business mailing address

759 45TH AVE SUITE 101
MUNSTER IN
46321-2938
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-6226
  • Fax:
Mailing address:
  • Phone: 219-922-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01065114A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: