Healthcare Provider Details

I. General information

NPI: 1881803047
Provider Name (Legal Business Name): MICHAEL PAUL BROOKS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19682 HESPERIAN BLVD STE 101A
HAYWARD CA
94541-4752
US

IV. Provider business mailing address

5051 PROCTOR AVE
OAKLAND CA
94618-2546
US

V. Phone/Fax

Practice location:
  • Phone: 510-917-4949
  • Fax: 510-655-3341
Mailing address:
  • Phone: 510-917-4949
  • Fax: 510-655-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: