Provider Demographics
NPI:1932268414
Name:KURT J BROTHERSON MD
Entity type:Organization
Organization Name:KURT J BROTHERSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:BROTHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-241-4129
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:STE 440
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-241-4129
Mailing Address - Fax:818-241-0472
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:STE 440
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-241-4129
Practice Address - Fax:818-241-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37748Medicare UPIN