Healthcare Provider Details

I. General information

NPI: 1487856670
Provider Name (Legal Business Name): MICHAEL JOHN BRUMFIELD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W 12TH ST STE 112
PERU IN
46970-1654
US

IV. Provider business mailing address

285 W 12TH ST STE 112
PERU IN
46970-1654
US

V. Phone/Fax

Practice location:
  • Phone: 765-475-2388
  • Fax: 260-479-2928
Mailing address:
  • Phone: 765-475-2388
  • Fax: 260-479-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02004189A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number005854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: