Provider Demographics
NPI:1326020884
Name:BRINKOP, MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BRINKOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-384-3966
Practice Address - Street 1:13161 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LE GRAND
Practice Address - State:CA
Practice Address - Zip Code:95333-9766
Practice Address - Country:US
Practice Address - Phone:209-389-1900
Practice Address - Fax:209-389-1907
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A751410OtherBLUE SHIELD OF CA PIN
CA00A751410Medicaid
CA00A751410Medicaid
CA00A751410Medicare ID - Type Unspecified
CA00A751410Medicaid