MEDICARE: BROOKE M. RUMMELHOFF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		MI
2	363A00000X	Physician Assistant	085-002439	IL

General Provider Information

NPI Number	:	1497942395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE M. RUMMELHOFF PA-C

Provider Business Mailing Address
First Line	:	1400 W ICE LAKE RD
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-9526
Country	:	US
Telephone Number	:	906-265-6121
Fax Number	:	906-265-4245

Provider Business Practice Location Address
First Line	:	927 RIVERSIDE PLZ
Second Line	:
City	:	IRON RIVER
State	:	MI
Zip	:	49935-1529
Country	:	US
Telephone Number	:	906-265-2165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	10/15/2015

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Directions to “ BROOKE M. RUMMELHOFF PA-C” Practice Location

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