Provider Demographics
NPI:1588976377
Name:BREWER, MICHAEL ROSS (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROSS
Last Name:BREWER
Suffix:
Gender:M
Credentials:DPM
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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
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0709213ES0103X
HIPO-228213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6687040001Medicare NSC