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General NPI Number Information
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NPI Number | 1467836296
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Entity Type | Organization
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Legal Business Name | BRENT J. MICHAEL, MD, INC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD STE 470W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2181
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Country | US
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Telephone | 310-829-7777
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Fax | 310-829-9951
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Provider Business Mailing Address
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Address Line | 2001 SANTA MONICA BLVD STE 470W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2181
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Country | US
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Telephone | 310-829-7777
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Fax | 310-829-9951
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT JAMES MICHAEL
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Credential | M.D.
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Telephone | 310-829-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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