Provider Demographics
NPI:1437579588
Name:ALAN BRENNER KIMELMAN MD PC
Entity Type:Organization
Organization Name:ALAN BRENNER KIMELMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-408-3500
Mailing Address - Street 1:1748 NOVATO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-7855
Mailing Address - Country:US
Mailing Address - Phone:415-408-3500
Mailing Address - Fax:
Practice Address - Street 1:1748 NOVATO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-7855
Practice Address - Country:US
Practice Address - Phone:415-408-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49358207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493580OtherMEDICARE PTAN #
CAA51340Medicare UPIN