Provider Demographics
NPI:1457794067
Name:MICHAEL BROUKHIM, M.D. PC
Entity Type:Organization
Organization Name:MICHAEL BROUKHIM, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-441-2000
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 1:1762 WESTWOOD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5632
Practice Address - Country:US
Practice Address - Phone:310-441-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED HEALTH CARE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101434207R00000X, 207RC0000X, 207RI0011X, 261QM2500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty