Provider Demographics
NPI:1467836296
Name:BRENT J. MICHAEL, MD, INC
Entity Type:Organization
Organization Name:BRENT J. MICHAEL, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-7777
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 470W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2181
Mailing Address - Country:US
Mailing Address - Phone:310-829-7777
Mailing Address - Fax:310-829-9951
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 470W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2181
Practice Address - Country:US
Practice Address - Phone:310-829-7777
Practice Address - Fax:310-829-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty