Healthcare Provider Details

I. General information

NPI: 1346411246
Provider Name (Legal Business Name): ROBERT T BRENGEL DO & OLAN C DOMBROSKE DO, PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 CADE RD
BROWN CITY MI
48416-9778
US

IV. Provider business mailing address

7115 CADE RD
BROWN CITY MI
48416-9778
US

V. Phone/Fax

Practice location:
  • Phone: 810-346-2757
  • Fax: 810-346-2016
Mailing address:
  • Phone: 810-346-2757
  • Fax: 810-346-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT T BRENGEL
Title or Position: PARTNER
Credential: D.O.
Phone: 810-346-2757