Healthcare Provider Details

I. General information

NPI: 1710915244
Provider Name (Legal Business Name): ROBERT C BROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 UNIVERSITY COMMONS SUITE 360
SOUTH BEND IN
46635-1571
US

IV. Provider business mailing address

6301 UNIVERSITY COMMONS SUITE 360
SOUTH BEND IN
46635-1571
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-4800
  • Fax: 574-280-4810
Mailing address:
  • Phone: 574-232-4800
  • Fax: 574-280-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01029129
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: