Provider Demographics
NPI:1104876945
Name:BRENNAN, PATRICK JAMES (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 THEDA CLARK MEDICAL PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2763
Mailing Address - Country:US
Mailing Address - Phone:920-725-4527
Mailing Address - Fax:920-725-0991
Practice Address - Street 1:100 THEDA CLARK MEDICAL PLZ
Practice Address - Street 2:SUITE 400
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2763
Practice Address - Country:US
Practice Address - Phone:920-725-4527
Practice Address - Fax:920-725-0991
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI44570208600000X, 2086S0102X, 2086S0127X, 2086S0129X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34211900Medicaid
WI34211900Medicaid
WI000071445Medicare PIN
000571445Medicare PIN
020052482Medicare ID - Type UnspecifiedRAILROAD