Active NPI
William Michael Brennan
- Athletic Trainer
- Lapeer, MI
National Provider Identifier
1578100376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 5302027722
- Practice address
- 540 S Main St
Lapeer, MI 48446-2467 - Phone
- (810) 664-0391
- Fax
- (810) 664-7079
- NPI assigned
- Nov 30, 2019
- Last updated
- Nov 30, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 5302027722 | MI | Primary |
Addresses
Primary practice location
540 S Main St
Lapeer, MI 48446-2467
Mailing address
540 S Main St
Lapeer, MI 48446-2467
Phone (810) 664-0391
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302027722 | Other | MI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302027722 | MI | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co of Michigan | Past | Accepting new patients | |
| Kroger Co of Michigan | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575072000000",
"number": "1578100376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 S MAIN ST",
"city": "LAPEER",
"state": "MI",
"postal_code": "484462467",
"telephone_number": "810-664-0391",
"fax_number": "810-664-7079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 S MAIN ST",
"city": "LAPEER",
"state": "MI",
"postal_code": "484462467",
"telephone_number": "810-664-0391",
"fax_number": "810-664-7079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "WILLIAM",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-30",
"last_updated": "2019-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "5302027722",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "5302027722",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lapeer, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.