Provider Demographics
NPI:1689655722
Name:DEBRULE, MICHAEL B (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:DEBRULE
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 1:6600 LYNDALE AVE S
Mailing Address - Street 2:SUITE#130
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3380
Mailing Address - Country:US
Mailing Address - Phone:612-788-8778
Mailing Address - Fax:
Practice Address - Street 1:6600 LYNDALE AVE S
Practice Address - Street 2:SUITE#130
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3380
Practice Address - Country:US
Practice Address - Phone:612-788-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN679213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6800620Medicaid
MN59G29DEOtherBCBS OF MN
MN1689655722Medicaid
MN59G29DEOtherBCBS OF MN
SD6800620Medicaid