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NPI Code Detail

MEDICARE: BROOKLYN MEDICAL ASSOCIATES LLC

MEDICARE: BROOKLYN MEDICAL ASSOCIATES LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2207Q00000XFamily Medicine Physician50000594AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548209877
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKLYN MEDICAL ASSOCIATES LLC
Provider Business Mailing Address
First Line : 3534 BROOKLYN AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-1361
Country : US
Telephone Number : 260-747-6171
Fax Number : 260-478-5125
Provider Business Practice Location Address
First Line : 2516 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1608
Country : US
Telephone Number : 260-747-6171
Fax Number : 260-478-5125
Authorized Official
Title or Position : DIRECTOR
Name : DEBBIE BREWER
Credential :
Telephone Number : 877-892-9813
Provider Enumeration Date : 06/05/2006
Last Update Date : 12/08/2011

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Directions to “BROOKLYN MEDICAL ASSOCIATES LLC ” Practice Location

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