MEDICARE: DR. MICHAEL B BRENNER M.D.

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	207W00000X	Ophthalmology Physician	G63953	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00197462	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841222023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL B BRENNER M.D.

Provider Business Mailing Address
First Line	:	3950 LONG BEACH BLVD
Second Line	:	SUITE #200
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5411
Country	:	US
Telephone Number	:	562-595-1291
Fax Number	:	562-981-2227

Provider Business Practice Location Address
First Line	:	3950 LONG BEACH BLVD
Second Line	:	SUITE #200
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5411
Country	:	US
Telephone Number	:	562-595-1291
Fax Number	:	562-981-2227

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/16/2012

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