Provider Demographics
NPI:1609864495
Name:COUGHLIN, BRENDA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:1522 JANES AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-755-1316
Practice Address - Fax:989-755-0956
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1010620OtherMCLAREN HEALTH PLAN
MI106OtherCOMMUNITY CHOICE OF MI
MI0983671OtherHEALTHPLUS OF MICHIGAN
122817OtherGREAT LAKES HEALTH PLAN
MI1609864495Medicaid
MI3500576OtherMOLINA HEALTH CARE OF MI
080130736OtherRAILROAD MEDICARE
1010620OtherHEALTH ADVANTAGE PPO
381908328OtherUNITED HEALTH CARE
5380695OtherAETNA
381908328OtherFIRST HEALTH
381908328OtherPPOM
MI080G310660OtherBLUE CARE NETWORK
MI080G310660OtherBCBS OF MICHIGAN
381908328OtherHCAP
1010620OtherHEALTH ADVANTAGE PPO
MI1609864495Medicaid