Healthcare Provider Details

I. General information

NPI: 1154351153
Provider Name (Legal Business Name): JOHN F. BRENNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SPRING STREET SUITE 600
RACINE WI
53405-1660
US

IV. Provider business mailing address

3803 SPRING STREET SUITE 600
RACINE WI
53405-1660
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-8312
  • Fax: 262-687-8796
Mailing address:
  • Phone: 262-687-8312
  • Fax: 262-687-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37698
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37698
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: