Healthcare Provider Details

I. General information

NPI: 1164048500
Provider Name (Legal Business Name): MARGARET BRENNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12680 OLIVE BLVD STE 300
SAINT LOUIS MO
63141-6322
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-8888
  • Fax: 573-814-2784
Mailing address:
  • Phone: 314-251-8888
  • Fax: 314-251-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023015152
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: