Provider Demographics
NPI:1679567572
Name:BRENNAN, BRIGIT K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIGIT
Middle Name:K
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:1005 W GREEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1712
Practice Address - Country:US
Practice Address - Phone:269-948-3632
Practice Address - Fax:269-948-9874
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301054210OtherMICHIGAN LICENSE
MIM28750022Medicare PIN
MI020Z81001OtherBLUE CROSS BLUE SHIELD
MIG11920Medicare UPIN