Healthcare Provider Details

I. General information

NPI: 1831301126
Provider Name (Legal Business Name): DANA CARYL BREWINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 W 87TH STREET PKWY STE 135
LENEXA KS
66215-2812
US

IV. Provider business mailing address

PO BOX 741331
ATLANTA GA
30374-1331
US

V. Phone/Fax

Practice location:
  • Phone: 913-438-6700
  • Fax: 913-438-6804
Mailing address:
  • Phone: 913-469-0503
  • Fax: 913-338-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2010014070
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-32541
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: