Provider Demographics
NPI:1376423574
Name:KISER, BROOKE (CMA (AAMA))
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KISER
Suffix:
Gender:F
Credentials:CMA (AAMA)
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMA (AAMA)
Mailing Address - Street 1:25271 HAYES BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4164
Mailing Address - Country:US
Mailing Address - Phone:586-265-7901
Mailing Address - Fax:
Practice Address - Street 1:6900 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1168
Practice Address - Country:US
Practice Address - Phone:586-501-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2521548171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator