Provider Demographics
NPI:1053414474
Name:BEHREND, TERRY ALAN (DO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ALAN
Last Name:BEHREND
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:1807 M 55
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661
Mailing Address - Country:US
Mailing Address - Phone:989-345-1237
Mailing Address - Fax:989-345-7480
Practice Address - Street 1:1807 M 55
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-345-1237
Practice Address - Fax:989-345-7480
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101007640OtherLICENSE
MI2107338Medicaid
MI5650001Medicare PIN
MI2107338Medicaid