Provider Demographics
NPI:1699968875
Name:MICHAEL B DEBRULE DPM, PA
Entity type:Organization
Organization Name:MICHAEL B DEBRULE DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEBRULE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-532-4676
Mailing Address - Street 1:200 OCONNELL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3773
Mailing Address - Country:US
Mailing Address - Phone:507-532-4676
Mailing Address - Fax:507-929-1041
Practice Address - Street 1:301 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1328
Practice Address - Country:US
Practice Address - Phone:507-532-4676
Practice Address - Fax:507-929-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN439392900Medicaid
MN59G28DEOtherBCBS
MN59G28DEOtherBCBS
MN439392900Medicaid
MN5416230001Medicare NSC