Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | MD11837 | HI |
NPI | 1275538423 |
---|---|
Provider Name | Mr. Michael A Brodsky |
First Address | Santa Ana, CA 92705-3612 |
Second Address | Santa Ana, CA 92705-3612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 13/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000255315 | HMSA BILLING NUMBER (01) | HI |
57286901 | (05) | HI |
A46153 | (02) | CA |
A46153 | (02) | HI |
GR0059850 | (05) | CA |