Provider Demographics
NPI:1962401273
Name:BROCHNER, MICHELLE L (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BROCHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD STE 825
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5338
Mailing Address - Country:US
Mailing Address - Phone:972-596-1300
Mailing Address - Fax:972-596-1349
Practice Address - Street 1:4708 ALLIANCE BLVD STE 825
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5338
Practice Address - Country:US
Practice Address - Phone:972-596-1300
Practice Address - Fax:972-596-1349
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201060956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG43600Medicare UPIN
TX8D7836Medicare PIN
TX8D7838Medicare PIN
TXA4968Medicare ID - Type Unspecified