Provider Demographics
NPI:1366492001
Name:BRARENS, ROBERT M (DPM, FACFAS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BRARENS
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 MASON MONTGOMERY RD # 4B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-3705
Mailing Address - Country:US
Mailing Address - Phone:513-489-2400
Mailing Address - Fax:513-489-2455
Practice Address - Street 1:11821 MASON MONTGOMERY RD # 4B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-3705
Practice Address - Country:US
Practice Address - Phone:513-489-2400
Practice Address - Fax:513-489-2455
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003288213E00000X
OH36.003288213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2663078Medicaid
OH000000674941OtherANTHEM
OH01378400OtherAMERIGROUP
OH751247OtherBUCKEYE
OH27-2930945-016OtherMEDICAL MUTUAL
OH272930945-051OtherCARESOURCE
OH7601544OtherAETNA
OH01378400OtherAMERIGROUP
OH27-2930945-016OtherMEDICAL MUTUAL
OH751247OtherBUCKEYE
OH6479320001Medicare NSC