Healthcare Provider Details

I. General information

NPI: 1225190259
Provider Name (Legal Business Name): MICHAEL T BREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 38TH ST SUITE 202
AUSTIN TX
78705-1188
US

IV. Provider business mailing address

1601 RIO GRANDE ST SUITE 340
AUSTIN TX
78701-1137
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8670
  • Fax: 512-380-7531
Mailing address:
  • Phone: 512-324-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF9233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: