Provider Demographics
NPI:1750685525
Name:MICHAEL R BREWER DPM PC
Entity Type:Organization
Organization Name:MICHAEL R BREWER DPM PC
Other - Org Name:MAUI FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-385-0938
Mailing Address - Street 1:115 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1717
Mailing Address - Country:US
Mailing Address - Phone:808-647-0579
Mailing Address - Fax:808-400-5890
Practice Address - Street 1:115 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1717
Practice Address - Country:US
Practice Address - Phone:808-647-0579
Practice Address - Fax:808-400-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ709213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6687040001Medicare NSC