Provider Demographics
NPI:1407136658
Name:MIGHT, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8450
Mailing Address - Country:US
Mailing Address - Phone:419-455-7790
Mailing Address - Fax:419-443-0036
Practice Address - Street 1:2495 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8450
Practice Address - Country:US
Practice Address - Phone:419-455-7790
Practice Address - Fax:419-443-0036
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12551NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053212Medicaid
OHH030782Medicare PIN