Provider Demographics
NPI:1477110724
Name:BRENNAN, VINCENT JOHN JR (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:BRENNAN
Suffix:JR
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30795 23 MILE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5721
Mailing Address - Country:US
Mailing Address - Phone:586-421-1600
Mailing Address - Fax:586-421-2002
Practice Address - Street 1:30795 23 MILE RD STE 207
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5721
Practice Address - Country:US
Practice Address - Phone:586-421-1600
Practice Address - Fax:586-421-2002
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101025979207Q00000X
OH34.015971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program