Provider Demographics
NPI:1568455970
Name:MOSKOVITZ, BRENDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:MOSKOVITZ
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 1:415 E MAPLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2720
Mailing Address - Country:US
Mailing Address - Phone:248-524-1001
Mailing Address - Fax:248-528-2533
Practice Address - Street 1:415 E MAPLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2720
Practice Address - Country:US
Practice Address - Phone:248-524-1001
Practice Address - Fax:248-528-2533
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM403917207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P36100Medicare ID - Type UnspecifiedMEDICARE GROUP ID#
MIE50126Medicare UPIN