Provider Demographics
NPI:1437185394
Name:BRENINGSTALL, GALEN NATLEY (MD)
Entity type:Individual
Prefix:DR
First Name:GALEN
Middle Name:NATLEY
Last Name:BRENINGSTALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 486
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-7466
Mailing Address - Fax:612-624-7681
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25830208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN05-00144OtherMEDICA PRIMARY
MN100896OtherUCARE
MN1021389OtherPREFERRED ONE
MN600T6BROtherBCBS
MN813701OtherARAZ
MNHP10171OtherHEALTHPARTNERS
MT0095098Medicaid
WI31436500Medicaid
MNB578OtherCHAMPUS
MN05-00501OtherMEDICA CHOICE
MN05-00144OtherMEDICA PRIMARY