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General NPI Number Information
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NPI Number | 1417187808
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Entity Type | Organization
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Legal Business Name | A DEN BREEIJEN M D P A
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 1355 E MAIN ST
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City | LAKELAND
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State | FL
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Zip | 33801-5714
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Country | US
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Telephone | 368-682-8482
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Fax | 863-684-3824
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Provider Business Mailing Address
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Address Line | 1355 E MAIN ST
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City | LAKELAND
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State | FL
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Zip | 33801-5714
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Country | US
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Telephone | 368-682-8482
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Fax | 863-684-3824
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARIE DEN BREEIJEN
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Credential | MD
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Telephone | 863-682-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0010918
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License Number State | FL
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