Provider Demographics
NPI:1881695039
Name:BROOKS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5372
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0372
Mailing Address - Country:US
Mailing Address - Phone:302-832-1545
Mailing Address - Fax:302-834-4863
Practice Address - Street 1:1941 LIMESTONE RD STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5424
Practice Address - Country:US
Practice Address - Phone:302-832-1545
Practice Address - Fax:302-834-4863
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2212163000OtherKEYSTONE
DE3280620OtherAETNA HMO
DEG24671OtherBLUE CROSS BLUE SHIELD
DE1000023211Medicaid
DE2212163000OtherPERSONAL CHOICE
DEP00186386OtherRAILROAD MEDICARE NUMBER
DE000000212086OtherUNISON HEALTH PLAN
DE2212163000OtherAMERIHEALTH
DE4326528OtherAETNA PPO
DEP00186386OtherRAILROAD MEDICARE NUMBER
DEG24671OtherBLUE CROSS BLUE SHIELD