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Contact Information

JENNIFER A BRAKE, MD
111 W JEFFERSON BLVD
STE 100
SOUTH BEND, IN46601-1994
 Phone: 574-647-1669
 Fax: 574-239-6461
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JENNIFER A BRAKE · (Female)

NPI Number 1093726713
Status Active
Credentials MD
Entity Individual
Enumeration date 08/10/2006
Last updated 03/04/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01058572A
  • IN Medicaid 200475200
  • IN Other 000000914885 BCBS BMG E. BLAIR WARNER
  • IN Other 000000914879 BCBS BMG SPORTS MEDICINE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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