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General NPI Number Information
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NPI Number | 1215016027
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Entity Type | Individual
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Provider Name | MICHAEL ALAN BROG MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 225 S MERAMEC AVE SUITE 932T
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City | CLAYTON
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State | MO
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Zip | 63105-3511
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Country | US
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Telephone | 314-432-7545
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Fax | 314-863-2114
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Provider Business Mailing Address
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Address Line | 225 S MERAMEC AVE SUITE 932T
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City | CLAYTON
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State | MO
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Zip | 63105-3511
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Country | US
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Telephone | 314-432-7545
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Fax | 314-863-2114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD100627
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License Number State | MO
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