Basic Information
| Provider Information | |||||||||
| NPI: | 1346411246 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROBERT T BRENGEL DO & OLAN C DOMBROSKE DO, PTRS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BROWN CITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462757 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Practice Location | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462757 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRENGEL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8103462757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.