Healthcare Provider Details

I. General information

NPI: 1063780062
Provider Name (Legal Business Name): MICHAEL BROOKS DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S MAIN ST
CYNTHIANA KY
41031-1548
US

IV. Provider business mailing address

214 S MAIN ST
CYNTHIANA KY
41031-1548
US

V. Phone/Fax

Practice location:
  • Phone: 859-234-8355
  • Fax: 859-235-0253
Mailing address:
  • Phone: 859-234-8355
  • Fax: 859-235-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberNS-1698
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: