Provider Demographics
NPI:1609064880
Name:BROUKHIM, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BROUKHIM
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 1:1762 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5632
Mailing Address - Country:US
Mailing Address - Phone:310-441-2000
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 360W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2175
Practice Address - Country:US
Practice Address - Phone:310-829-7878
Practice Address - Fax:310-829-6889
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101434207R00000X, 207RC0000X, 261QM2500X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty