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General NPI Number Information
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NPI Number | 1407388820
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Entity Type | Individual
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Provider Name | BRENDAN COUTU M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 11/26/2022
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Provider Practice Location Address
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Address Line | 1215 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-1811
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Country | US
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Telephone | 269-567-9835
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Fax | 269-567-9841
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Provider Business Mailing Address
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Address Line | 6411 PINE HOLLOW DR
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City | EAST LANSING
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State | MI
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Zip | 48823-9737
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Country | US
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Telephone | 269-567-9835
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Fax | 269-567-9841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 4301506379
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License Number State | MI
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