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General NPI Number Information
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NPI Number | 1932763927
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Entity Type | Individual
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Provider Name | MICHAEL JORDAN BRASSELL DPM
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Gender | Male
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 730 THIMBLE SHOALS BLVD STE 130
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4562
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Country | US
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Telephone | 757-873-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 730 THIMBLE SHOALS BLVD STE 130
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4562
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Country | US
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Telephone | 757-873-1554
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103301346
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 0103301346
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0103301346
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301346
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License Number State | VA
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