=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114992674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL BRENNER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2006
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 PLAZA DR
-----------------------------------------------------
City | SOUTH SIOUX CITY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68776-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-412-4220
-----------------------------------------------------
Fax | 402-412-4222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 PIERCE ST STE 300
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51101-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-226-2600
-----------------------------------------------------
Fax | 712-226-2605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35697
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23232
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------