Organization
BROTMAN MEDICAL ANESTHESIA GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KELLY M.D. (DIRECT OWNER)
(818) 888-7815
Entity
Organization
Contact information
Practice address
20750 VENTURA BLVD, STE. #210, WOODLAND HILLS, CA 91364-2338
(818) 888-7815
(818) 715-1722
Mailing address
PO BOX 7001, TARZANA, CA 91357-7001
(818) 888-7815
(818) 715-1722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A69217
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
A69217
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0103820
EDS MEDICAL
CA
Enumeration date
05/31/2006
Last updated
07/19/2017
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