Provider Demographics
NPI:1154315695
Name:BREWINGTON, KENNETH C II (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:BREWINGTON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 WEST BROADWAY STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4012
Mailing Address - Country:US
Mailing Address - Phone:406-728-6520
Mailing Address - Fax:406-329-2936
Practice Address - Street 1:500 WEST BROADWAY STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4012
Practice Address - Country:US
Practice Address - Phone:406-728-6520
Practice Address - Fax:406-329-2936
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT9721207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0035763Medicaid
MT0035763Medicaid
MT5482060001Medicare NSC