Provider Demographics
NPI:1326024183
Name:HOMER, BRIAN ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ERIC
Last Name:HOMER
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 1:615 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1901
Mailing Address - Country:US
Mailing Address - Phone:248-288-8900
Mailing Address - Fax:248-288-8989
Practice Address - Street 1:615 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1901
Practice Address - Country:US
Practice Address - Phone:248-288-8900
Practice Address - Fax:248-288-8989
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901BH001699213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F318080OtherBLUE CROSS -CLAWSON
MI48OH2128370OtherALLEN PARK BLUE CROSS
MIP00102057OtherMEDICARE RAILROAD ALLEN PARK
MI1283450001OtherCLAWSON DME NUMBER
MI0F383890OtherBCBS DME CLAWSON
MI4319060001OtherALLEN PARK DME
MI0H20650OtherBCBS DME ALLEN PART
MI480018640OtherMEDICARE RAILROAD CLAWSON
MI4319060001OtherALLEN PARK DME
MION31390Medicare ID - Type UnspecifiedALLEN PARK MEDICARE
MI0F383890OtherBCBS DME CLAWSON