Basic Information
| Provider Information | |||||||||
| NPI: | 1154913390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | ARNP, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4661 72ND ST | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503221172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237653070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1212 PLEASANT ST STE 406 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503091413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152418336 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2021 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | C154366 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.