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NPI Code Detail

MEDICARE: MARY T BREGER MD

MEDICARE: MARY T BREGER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician26922-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033470489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY T BREGER MD
Provider Business Mailing Address
First Line : 4555 W SCHROEDER DR
Second Line : SUITE 170
City : MILWAUKEE
State : WI
Zip : 53223-1496
Country : US
Telephone Number : 414-365-3210
Fax Number : 414-365-3225
Provider Business Practice Location Address
First Line : 7007 N RANGE LINE RD
Second Line :
City : GLENDALE
State : WI
Zip : 53209-2620
Country : US
Telephone Number : 414-352-3341
Fax Number : 414-247-4588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2012
Last Update Date : 06/01/2012

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