=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851368591
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN BRENNER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4936 W CLARK RD SUITE 101
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-0861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-434-3000
-----------------------------------------------------
Fax | 734-434-8040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 FRANK LLOYD WRIGHT DR PO BOX 0446
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-747-6766
-----------------------------------------------------
Fax | 734-222-3100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301070174
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------