Healthcare Provider Details

I. General information

NPI: 1326136060
Provider Name (Legal Business Name): MIRA J BROOKS AU.D. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 E 12 MILE RD STE 111
SAINT CLAIR SHORES MI
48081-1156
US

IV. Provider business mailing address

21000 E 12 MILE RD STE 110
SAINT CLAIR SHORES MI
48081-1184
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-2400
  • Fax: 586-779-0031
Mailing address:
  • Phone: 586-779-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: