Provider Demographics
NPI:1730535162
Name:BRODEUR, TIA YAA ASANTEWA (MD)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:YAA ASANTEWA
Last Name:BRODEUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:BUMPUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:500 N KEENE ST STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8144
Practice Address - Country:US
Practice Address - Phone:573-817-3101
Practice Address - Fax:573-499-6065
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01090134A207V00000X
MO2025013271207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN896330098OtherMEDICARE PTAN
IN300078645Medicaid