Healthcare Provider Details

I. General information

NPI: 1194715854
Provider Name (Legal Business Name): DAVID ALLEN BREITWEISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S MURPHY AVE SUITE A
BRAZIL IN
47834-8296
US

IV. Provider business mailing address

115 S MURPHY AVE STE A
BRAZIL IN
47834-8397
US

V. Phone/Fax

Practice location:
  • Phone: 812-442-2100
  • Fax: 812-446-4409
Mailing address:
  • Phone: 812-442-2100
  • Fax: 812-446-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01043952
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: