Provider Demographics
NPI:1114412368
Name:BRUTICO, SOKIEU MACH (DPM)
Entity Type:Individual
Prefix:
First Name:SOKIEU
Middle Name:MACH
Last Name:BRUTICO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SOKIEU
Other - Middle Name:
Other - Last Name:MACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:30 LINCOLN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1907
Mailing Address - Country:US
Mailing Address - Phone:570-936-2960
Mailing Address - Fax:570-936-2961
Practice Address - Street 1:30 LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1907
Practice Address - Country:US
Practice Address - Phone:570-936-2960
Practice Address - Fax:570-936-2961
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006926213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery