Provider Demographics
NPI:1588846422
Name:MICHAEL J BRENNAN MD PC
Entity Type:Organization
Organization Name:MICHAEL J BRENNAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:602-667-6640
Mailing Address - Street 1:2222 E HIGHLAND AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4881
Mailing Address - Country:US
Mailing Address - Phone:602-667-6640
Mailing Address - Fax:602-667-3191
Practice Address - Street 1:2222 E HIGHLAND AVE STE 425
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4881
Practice Address - Country:US
Practice Address - Phone:602-667-6640
Practice Address - Fax:602-667-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA52180Medicare UPIN
AZZ29209Medicare PIN
AZZ29208Medicare PIN