Healthcare Provider Details

I. General information

NPI: 1881973014
Provider Name (Legal Business Name): IGAL BREITMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IGAL BRIGHTMAN M.D

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5741
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax:
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-121676
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number64663
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number662
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number464
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: