MEDICARE: ELLIOTT M BRUMER DPM

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	213E00000X	Podiatrist	E2230	CA

General Provider Information

NPI Number	:	1902841174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIOTT M BRUMER DPM

Provider Business Mailing Address
First Line	:	2120 W 8TH ST
Second Line	:	#330
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4019
Country	:	US
Telephone Number	:	213-385-2400
Fax Number	:	213-385-2403

Provider Business Practice Location Address
First Line	:	2120 W 8TH ST
Second Line	:	#330
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4019
Country	:	US
Telephone Number	:	213-385-2400
Fax Number	:	213-385-2403

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/30/2009

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