Individual
MICHAEL P. BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5348 LAMME RD, MORAINE, OH 45439-3215
(937) 534-4651
(937) 522-8799
Mailing address
5348 LAMME RD, MORAINE, OH 45439-3215
(937) 534-4651
(937) 522-8799
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.024158
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0342029
—
OH
01
—
H709731
MEDICARE
OH
Enumeration date
11/09/2016
Last updated
11/23/2020
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