Provider Demographics
NPI:1558716357
Name:CERK, BRENDAN (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:CERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4803
Mailing Address - Country:US
Mailing Address - Phone:213-482-2770
Mailing Address - Fax:562-967-2468
Practice Address - Street 1:1245 WILSHIRE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4803
Practice Address - Country:US
Practice Address - Phone:213-482-2770
Practice Address - Fax:562-967-2468
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154575207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program