Healthcare Provider Details

I. General information

NPI: 1326024183
Provider Name (Legal Business Name): BRIAN ERIC HOMER D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W 14 MILE RD
CLAWSON MI
48017-1901
US

IV. Provider business mailing address

615 W 14 MILE RD
CLAWSON MI
48017-1901
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-8900
  • Fax: 248-288-8989
Mailing address:
  • Phone: 248-288-8900
  • Fax: 248-288-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901BH001699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: