Individual
TIA YAA ASANTEWA BRODEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 N KEENE ST STE 203, COLUMBIA, MO 65201-8144
(573) 817-3101
(573) 499-6065
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01090134A
IN
207V00000X
Obstetrics & Gynecology Physician
2025013271
MO
207VE0102X
Reproductive Endocrinology Physician
Primary
2025013271
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300078645
—
IN
01
—
896330098
MEDICARE PTAN
IN
Enumeration date
05/04/2016
Last updated
04/22/2025
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