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General NPI Number Information
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NPI Number | 1699968875
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Entity Type | Organization
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Legal Business Name | MICHAEL B DEBRULE DPM, PA
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 301 N 3RD ST
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City | MARSHALL
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State | MN
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Zip | 56258-1328
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Country | US
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Telephone | 507-532-4676
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Fax | 507-929-1041
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Provider Business Mailing Address
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Address Line | 200 OCONNELL ST SUITE B
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City | MARSHALL
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State | MN
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Zip | 56258-3773
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Country | US
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Telephone | 507-532-4676
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Fax | 507-929-1041
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL B DEBRULE
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Credential | DPM
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Telephone | 507-532-4676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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