Healthcare Provider Details

I. General information

NPI: 1720044472
Provider Name (Legal Business Name): KARL HEINZ BREUING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST STE 501
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

117 ELLEFIELD STREET SUITE 101
PROVIDENCE RI
02905-4513
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5495
  • Fax: 401-444-5716
Mailing address:
  • Phone: 401-444-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD14821
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: