Provider Demographics
NPI:1841222023
Name:BRENNER, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3950 LONG BEACH BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5411
Mailing Address - Country:US
Mailing Address - Phone:562-595-1291
Mailing Address - Fax:562-981-2227
Practice Address - Street 1:3950 LONG BEACH BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5411
Practice Address - Country:US
Practice Address - Phone:562-595-1291
Practice Address - Fax:562-981-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG63953207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00197462OtherRAILROAD MEDICARE
CA00G639531Medicaid
CAE89521Medicare UPIN
CAWG63953EMedicare PIN
CAG63953Medicare PIN
CAW14926Medicare PIN