Healthcare Provider Details

I. General information

NPI: 1447473962
Provider Name (Legal Business Name): BROOKS A YOUNG D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 MEADOW VIEW DR STE 101
SHAWNEE KS
66227-7288
US

IV. Provider business mailing address

9300 MEADOW VIEW DR STE 101
SHAWNEE KS
66227-7288
US

V. Phone/Fax

Practice location:
  • Phone: 913-871-2183
  • Fax: 913-815-8753
Mailing address:
  • Phone: 913-871-2183
  • Fax: 913-815-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number12-00368
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: