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General NPI Number Information
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NPI Number | 1457794067
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Entity Type | Organization
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Legal Business Name | MICHAEL BROUKHIM, M.D. PC
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 1762 WESTWOOD BLVD SUITE 300
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City | LOS ANGELES
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State | CA
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Zip | 90024-5632
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Country | US
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Telephone | 310-441-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 WESTWOOD BLVD SUITE 300
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City | LOS ANGELES
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State | CA
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Zip | 90024-5632
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Country | US
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Telephone | 310-441-2000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL BROUKHIM
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Credential | M.D.
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Telephone | 310-441-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A101434
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A101434
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A101434
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | A101434
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | A101434
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License Number State | CA
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