Healthcare Provider Details

I. General information

NPI: 1336999176
Provider Name (Legal Business Name): BROOKE REZMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST FL 3
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

550 S JACKSON ST FL 3
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 989-498-9455
  • Fax:
Mailing address:
  • Phone: 989-498-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: