MEDICARE: EDMUND J BRENNAN MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	28201	AZ
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	28201	AZ
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	65654	MT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	060057219	OTHER	AZ	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1Z5173	OTHER	AZ	HEALTHNET
2	2500514	OTHER	AZ	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1003812660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND J BRENNAN MD

Provider Business Mailing Address
First Line	:	1101 26TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5161
Country	:	US
Telephone Number	:	406-731-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 26TH ST S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5161
Country	:	US
Telephone Number	:	406-731-8888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/25/2018

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: