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NPI Code Detail

MEDICARE: BRENNAN ALLERGY CLINIC PROF LLC

MEDICARE: BRENNAN ALLERGY CLINIC PROF LLC
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
1207K00000XAllergy & Immunology Physician

General Provider Information

NPI Number : 1932468154
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRENNAN ALLERGY CLINIC PROF LLC
Provider Business Mailing Address
First Line : 210 N BROADWAY AVE
Second Line :
City : MILLER
State : SD
Zip : 57362-1414
Country : US
Telephone Number : 605-853-2786
Fax Number : 605-853-2653
Provider Business Practice Location Address
First Line : 5009 S BUR OAK PL
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57108-2228
Country : US
Telephone Number : 605-271-3500
Fax Number : 605-271-8220
Authorized Official
Title or Position : OWNER
Name : BRIAN A BRENNAN
Credential : MD
Telephone Number : 605-271-3500
Provider Enumeration Date : 05/08/2012
Last Update Date : 09/10/2013

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Directions to “BRENNAN ALLERGY CLINIC PROF LLC ” Practice Location

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