Healthcare Provider Details

I. General information

NPI: 1417946500
Provider Name (Legal Business Name): MARK A. BRIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 EXECUTIVE PKWY SUITE 200
TOLEDO OH
43606-1326
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FLOOR - CREDENTIALING
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-4666
  • Fax: 419-486-8855
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35050010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: