Provider Demographics
NPI:1659317667
Name:BRAND, MICHAEL RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RANDALL
Last Name:BRAND
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 1:5528 E LA PALMA AVE
Mailing Address - Street 2:SUITE 4-A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2115
Mailing Address - Country:US
Mailing Address - Phone:714-970-0200
Mailing Address - Fax:714-970-0270
Practice Address - Street 1:5528 E LA PALMA AVE
Practice Address - Street 2:SUITE 4-A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2115
Practice Address - Country:US
Practice Address - Phone:714-970-0200
Practice Address - Fax:714-970-0270
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG549892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G549890Medicaid
CA00G549890Medicare PIN
CAE85683Medicare UPIN
CAWG54989LMedicare PIN
CAWG54989BMedicare PIN
CAWG54989AMedicare PIN
CA00G549890Medicaid