MEDICARE: BREAKING THROUGH THERAPEUTICS PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1538996236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKING THROUGH THERAPEUTICS PLLC

Provider Business Mailing Address
First Line	:	37935 W 12 MILE RD STE A
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3035
Country	:	US
Telephone Number	:	313-408-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	37935 W 12 MILE RD STE A
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3035
Country	:	US
Telephone Number	:	313-408-3006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK GRESHAM
Credential	:	MD
Telephone Number	:	313-408-3006

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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