Provider Demographics
NPI:1881803047
Name:BROOKS, MICHAEL PAUL (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 PROCTOR AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2546
Mailing Address - Country:US
Mailing Address - Phone:510-917-4949
Mailing Address - Fax:510-655-3341
Practice Address - Street 1:19682 HESPERIAN BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:510-917-4949
Practice Address - Fax:510-655-3341
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1971213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19710Medicaid
CA000E19710Medicaid
CAT11109Medicare UPIN