Basic Information
| Provider Information | |||||||||
| NPI: | 1013983899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRENNER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | GAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673135 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482673135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344648300 | ||||||||
| FaxNumber: | 7344648301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S CANTON CENTER RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481881992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347134000 | ||||||||
| FaxNumber: | 7347134001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301072739 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.