Healthcare Provider Details

I. General information

NPI: 1801230982
Provider Name (Legal Business Name): BRENNAN MICHAEL LAWALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 MONTGOMERY RD STE 2500
MONTGOMERY OH
45249-2309
US

IV. Provider business mailing address

11140 MONTGOMERY RD STE 2500
MONTGOMERY OH
45249-2309
US

V. Phone/Fax

Practice location:
  • Phone: 513-561-7809
  • Fax: 513-272-4121
Mailing address:
  • Phone: 513-561-7809
  • Fax: 513-272-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.127687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: