Brake, Jennifer A

Brake, Jennifer A is an individual health care provider with primary practice located at 111 W Jefferson Blvd Ste 100, South Bend IN 46601-1994. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is her primary health care specialty. Brake, Jennifer A can be contacted via phone (574) 647-1669.

Contact Information

Primary practice address
111 W Jefferson Blvd Ste 100 South Bend IN 46601-1994
Phone: (574) 647-1669
Fax: (574) 239-6461
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 01058572A Indiana
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01058572A Indiana

Profile Details

NPI number 1093726713
LBN Legal business name Brake, Jennifer A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2006
Last updated Mar 4th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093726713 NPPES
Indiana Other 000000914885 BCBS BMG E. BLAIR WARNER
Indiana Other 000000914879 BCBS BMG E. BLAIR WARNER
Indiana MEDICAID 200475200 BCBS BMG E. BLAIR WARNER

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