Basic Information
| Provider Information | |||||||||
| NPI: | 1730561655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHEL | ||||||||
| FirstName: | BRENDAN | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 SW 160TH AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778667123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 437 LITTLE FISHER TRL | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270306900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363204009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2015 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 7580 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208D00000X | 2016-02394 | NC | N | Allopathic & Osteopathic Physicians | General Practice | 207QS0010X | 2016-02394 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.