Healthcare Provider Details

I. General information

NPI: 1457355372
Provider Name (Legal Business Name): WARREN M BREITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: W MARK BREITE MD

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 HIGHWAY 61 SUITE 2300
FESTUS MO
63028-4137
US

IV. Provider business mailing address

1390 HIGHWAY 61 STE 2300
FESTUS MO
63028-4121
US

V. Phone/Fax

Practice location:
  • Phone: 636-937-3121
  • Fax: 636-937-4423
Mailing address:
  • Phone: 636-937-3121
  • Fax: 636-937-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG9264
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number075585
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number106261
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01038424A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: