Provider Demographics
NPI:1366408833
Name:BROOK, STEVE (MD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:
Practice Address - Street 1:135 COURTHOUSE XING
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-2509
Practice Address - Country:US
Practice Address - Phone:859-356-6800
Practice Address - Fax:859-363-4073
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2289714Medicaid
KY64012339Medicaid
H04372Medicare UPIN
KY64012339Medicaid
KY0553240Medicare PIN
OH2289714Medicaid
KY00828002Medicare PIN