Provider Demographics
NPI:1225001746
Name:BRENNAN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43650 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7419
Mailing Address - Country:US
Mailing Address - Phone:586-263-0820
Mailing Address - Fax:586-263-3819
Practice Address - Street 1:43650 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7419
Practice Address - Country:US
Practice Address - Phone:586-263-0820
Practice Address - Fax:586-263-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014053242081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4815088Medicaid
0500244Medicare ID - Type Unspecified
B45700Medicare UPIN