Healthcare Provider Details

I. General information

NPI: 1184063349
Provider Name (Legal Business Name): DMITRIY BREYTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST GALTER SUITE 3-150
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

1304 DEVONSHIRE RD
BUFFALO GROVE IL
60089-1128
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-6895
  • Fax:
Mailing address:
  • Phone: 312-493-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013020177
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number336101860
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: