Healthcare Provider Details

I. General information

NPI: 1760458830
Provider Name (Legal Business Name): THOMAS A BREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLMAR AVE SW
WILLMAR MN
56201
US

IV. Provider business mailing address

101 WILLMAR AVE SW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax: 320-231-5067
Mailing address:
  • Phone: 320-231-5000
  • Fax: 320-231-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22015
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: