MEDICARE: BRENDA MARIE COUGHLIN MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301066408	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	080130736	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1010620	OTHER		MCLAREN HEALTH PLAN
2	106	OTHER	MI	COMMUNITY CHOICE OF MI
3	0983671	OTHER	MI	HEALTHPLUS OF MICHIGAN
4	122817	OTHER		GREAT LAKES HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	3500576	OTHER	MI	MOLINA HEALTH CARE OF MI
8	1010620	OTHER		HEALTH ADVANTAGE PPO
9	381908328	OTHER		UNITED HEALTH CARE
10	5380695	OTHER		AETNA
11	381908328	OTHER		FIRST HEALTH
12	381908328	OTHER		PPOM
13	080G310660	OTHER	MI	BLUE CARE NETWORK
14	080G310660	OTHER	MI	BCBS OF MICHIGAN
15	381908328	OTHER		HCAP

NPI Number	:	1609864495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE COUGHLIN MD

Provider Business Mailing Address
First Line	:	501 LAPEER
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48607-1208
Country	:	US
Telephone Number	:	989-759-6464
Fax Number	:	989-399-8233

Provider Business Practice Location Address
First Line	:	1522 JANES AVE
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-1819
Country	:	US
Telephone Number	:	989-755-1316
Fax Number	:	989-755-0956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/08/2021