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NPI Code Detail

MEDICARE: MARK A. BRIM, D.P.M., INC.

MEDICARE: MARK A. BRIM, D.P.M., INC.
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
1213E00000XPodiatristE1542CA

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 : 1861545576
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK A. BRIM, D.P.M., INC.
Provider Business Mailing Address
First Line : 17200 VENTURA BLVD
Second Line : SUITE 207
City : ENCINO
State : CA
Zip : 91316-4005
Country : US
Telephone Number : 818-783-3338
Fax Number : 818-583-1444
Provider Business Practice Location Address
First Line : 17200 VENTURA BLVD.
Second Line : SUITE 207
City : ENCINO
State : CA
Zip : 91316-2804
Country : US
Telephone Number : 818-783-3338
Fax Number : 818-583-1444
Authorized Official
Title or Position : PRESIDENT
Name : MARK A. BRIM
Credential : D.P.M.
Telephone Number : 818-783-3338
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/30/2013

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