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General NPI Number Information
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NPI Number | 1649216045
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Entity Type | Individual
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Provider Name | JODI L BREHM MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 10400 75TH ST
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City | KENOSHA
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State | WI
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Zip | 53142
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Country | US
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Telephone | 262-648-5600
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Fax | 262-948-5735
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Provider Business Mailing Address
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Address Line | 10400 75TH ST
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City | KENOSHA
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State | WI
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Zip | 53142-7884
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Country | US
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Telephone | 262-648-5600
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Fax | 262-948-5735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036112238
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 52096
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License Number State | WI
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