MEDICARE: DR. ROBERT D BRETZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	26336	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407833940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D BRETZ MD

Provider Business Mailing Address
First Line	:	879 OLD PRESTON HIGHWAY NORTH
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229
Country	:	US
Telephone Number	:	502-955-6480
Fax Number	:	502-955-6480

Provider Business Practice Location Address
First Line	:	879 OLD PRESTON HIGHWAY NORTH
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229
Country	:	US
Telephone Number	:	502-955-6480
Fax Number	:	502-955-6480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	03/25/2015

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