1609864495 NPI number — BRENDA MARIE COUGHLIN MD

Table of content: BRENDA MARIE COUGHLIN MD (NPI 1609864495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609864495 NPI number — BRENDA MARIE COUGHLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUGHLIN
Provider First Name:
BRENDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBER
Provider Other First Name:
BRENDA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609864495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 LAPEER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48607-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-759-6464
Provider Business Mailing Address Fax Number:
989-399-8233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1522 JANES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48601-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-755-1316
Provider Business Practice Location Address Fax Number:
989-755-0956
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301066408 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1010620 . This is a "MCLAREN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106 . This is a "COMMUNITY CHOICE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0983671 . This is a "HEALTHPLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 122817 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609864495 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3500576 . This is a "MOLINA HEALTH CARE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080130736 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1010620 . This is a "HEALTH ADVANTAGE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5380695 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "PPOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080G310660 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080G310660 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381908328 . This is a "HCAP" identifier . This identifiers is of the category "OTHER".




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