Healthcare Provider Details

I. General information

NPI: 1225001746
Provider Name (Legal Business Name): MARK J BRENNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43650 GARFIELD RD
CLINTON TOWNSHIP MI
48038-7419
US

IV. Provider business mailing address

43650 GARFIELD RD
CLINTON TOWNSHIP MI
48038-7419
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-0820
  • Fax: 586-263-3819
Mailing address:
  • Phone: 586-263-0820
  • Fax: 586-263-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301405324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: