MEDICARE: CHRISTINE GAY BRENNER MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301072739	MI

General Provider Information

NPI Number	:	1013983899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GAY BRENNER MD

Provider Business Mailing Address
First Line	:	PO BOX 673135
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-3135
Country	:	US
Telephone Number	:	734-464-8300
Fax Number	:	734-464-8301

Provider Business Practice Location Address
First Line	:	1600 S CANTON CENTER RD
Second Line	:	STE 200
City	:	CANTON
State	:	MI
Zip	:	48188-1992
Country	:	US
Telephone Number	:	734-713-4000
Fax Number	:	734-713-4001

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/03/2011

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