| Brent J. Michael, Md, Inc | |
|
2001 Santa Monica Blvd Ste 470w Santa Monica CA 90404-2181 | |
| (310) 829-7777 | |
| (310) 829-9951 |
| Full Name | Brent J. Michael, Md, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2001 Santa Monica Blvd Ste 470w, Santa Monica, California |
| Authorized Official Name and Position | Brent James Michael (PRESIDENT) |
| Authorized Official Contact | 3108297777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brent J. Michael, Md, Inc 2001 Santa Monica Blvd Ste 470w Santa Monica CA 90404-2181 Ph: (310) 829-7777 | Brent J. Michael, Md, Inc 2001 Santa Monica Blvd Ste 470w Santa Monica CA 90404-2181 Ph: (310) 829-7777 |
| NPI Number | 1467836296 |
|---|---|
| Provider Enumeration Date | 07/10/2015 |
| Last Update Date | 05/14/2021 |
| Medicare PECOS PAC ID | 2668780081 |
|---|---|
| Medicare Enrollment ID | O20151006000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467836296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brent J Michael |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275698052 PECOS PAC ID: 6507845815 Enrollment ID: I20040719001016 |
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