Healthcare Provider Details

I. General information

NPI: 1841474087
Provider Name (Legal Business Name): DANIEL C BROOKE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WILSON STREET SUITE 1
MILES CITY MT
59301
US

IV. Provider business mailing address

2600 WILSON ST STE 1
MILES CITY MT
59301-5094
US

V. Phone/Fax

Practice location:
  • Phone: 406-233-2520
  • Fax: 406-233-4062
Mailing address:
  • Phone: 406-233-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4617
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL C BROOKE
Title or Position: PRESIDENT
Credential: MD
Phone: 406-233-2520