Provider Demographics
NPI:1639117146
Name:MCCOLGAN, BRIAN PADRAIC (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PADRAIC
Last Name:MCCOLGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 SAVOY AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2174
Mailing Address - Country:US
Mailing Address - Phone:810-853-7585
Mailing Address - Fax:
Practice Address - Street 1:3909 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3602
Practice Address - Country:US
Practice Address - Phone:810-762-3662
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101016300OtherPHYSICIAN LICENSE