Provider Demographics
NPI:1356574115
Name:BRODER, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BRODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 S BEVERLY DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3907
Mailing Address - Country:US
Mailing Address - Phone:310-858-9555
Mailing Address - Fax:310-858-9552
Practice Address - Street 1:280 S BEVERLY DR
Practice Address - Street 2:SUITE 404
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3907
Practice Address - Country:US
Practice Address - Phone:310-858-9555
Practice Address - Fax:310-858-9552
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52301207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology