Healthcare Provider Details

I. General information

NPI: 1043715659
Provider Name (Legal Business Name): BROOKS DAVID KIMMIS MD, MAY 2018
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CHARLOTTE ST STE 110
KANSAS CITY MO
64108-2759
US

IV. Provider business mailing address

2101 CHARLOTTE ST STE 110
KANSAS CITY MO
64108-2759
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7810
  • Fax:
Mailing address:
  • Phone: 816-404-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD18034
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: