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General NPI Number Information
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NPI Number | 1902547094
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Entity Type | Individual
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Provider Name | BROOKE MICHELLE FAIRMAN DPM
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1265 WAYNE AVE STE 307
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City | INDIANA
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State | PA
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Zip | 15701-3501
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Country | US
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Telephone | 888-452-4762
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Fax |
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Provider Business Mailing Address
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Address Line | 406 EDGEWOOD AVE
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City | INDIANA
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State | PA
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Zip | 15701-7447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC007540
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License Number State | PA
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