Healthcare Provider Details

I. General information

NPI: 1528223484
Provider Name (Legal Business Name): BROOKE RENEE KWIECINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 RESEARCH PARK BLVD
MADISON WI
53719-1176
US

IV. Provider business mailing address

6001 RESEARCH PARK BLVD
MADISON WI
53719-1176
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6100
  • Fax: 608-262-9246
Mailing address:
  • Phone: 608-263-6100
  • Fax: 608-262-9246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53720
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number53720
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: