Healthcare Provider Details

I. General information

NPI: 1366492001
Provider Name (Legal Business Name): ROBERT M BRARENS DPM, FACFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11821 MASON MONTGOMERY RD # 4B
CINCINNATI OH
45249-3705
US

IV. Provider business mailing address

11821 MASON MONTGOMERY RD # 4B
CINCINNATI OH
45249-3705
US

V. Phone/Fax

Practice location:
  • Phone: 513-489-2400
  • Fax: 513-489-2455
Mailing address:
  • Phone: 513-489-2400
  • Fax: 513-489-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003288
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003288
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: