Healthcare Provider Details

I. General information

NPI: 1932468154
Provider Name (Legal Business Name): BRENNAN ALLERGY CLINIC PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 S BUR OAK PL
SIOUX FALLS SD
57108-2228
US

IV. Provider business mailing address

210 N BROADWAY AVE
MILLER SD
57362-1414
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-3500
  • Fax: 605-271-8220
Mailing address:
  • Phone: 605-853-2786
  • Fax: 605-853-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN A BRENNAN
Title or Position: OWNER
Credential: MD
Phone: 605-271-3500