Healthcare Provider Details

I. General information

NPI: 1346235801
Provider Name (Legal Business Name): MICHAEL P BREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NW 11TH PL STE 200
GAINESVILLE FL
32605-4201
US

IV. Provider business mailing address

6716 NW 11TH PL STE 200
GAINESVILLE FL
32605-4201
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9729
  • Fax: 352-331-0136
Mailing address:
  • Phone: 352-331-9729
  • Fax: 352-331-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME88652
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD060346L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME88652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: