Provider Demographics
NPI:1396714762
Name:BRENNAN, MICHAEL J (MD PC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
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Mailing Address - Street 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:# 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-667-6640
Mailing Address - Fax:602-667-3191
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:# 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-667-6640
Practice Address - Fax:602-667-3191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ21272207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ125436Medicaid
AZA52180Medicare UPIN
AZ125436Medicaid
AZZ29208Medicare PIN