MEDICARE: DR. MICAH JAMES BRAINERD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	A203220	CA

General Provider Information

NPI Number	:	1760019087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICAH JAMES BRAINERD MD

Provider Business Mailing Address
First Line	:	8631 W 3RD ST STE 710E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 710E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	989-574-8672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	08/15/2025

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