Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH11247 | FL |
N | 111NN0400X | Neurology | S01350 | MD |
NPI | 1326190729 |
---|---|
Provider Name | Dr. Michael Brandon Regan |
First Address | Lakewood Ranch, FL 34202-4175 |
Second Address | Lakewood Ranch, FL 34202-4175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 26/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2107050 | AETNA (01) | |
320469 | COVENTRY (01) | |
52-1934607 | TAX ID (01) | |
53603803 | CAREFIRST BCBS (01) | MD |
53603804 | BCBS (01) | MD |
E6530002 | CAREFIRST BLUE CHOICE (01) | MD |
E6530002 | FEDERAL BCBS (01) | |
T59498 | (02) | MD |