MEDICARE: WARREN MARK BREISBLATT 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
1	207RC0000X	Cardiovascular Disease Physician	24667	AZ
2	207RI0011X	Interventional Cardiology Physician	24667	AZ
3	207UN0901X	Nuclear Cardiology Physician	24667	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1063413177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN MARK BREISBLATT MD

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	STE. 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	602-214-6148
Fax Number	:	602-214-6149

Provider Business Practice Location Address
First Line	:	9250 N. 3RD STREET
Second Line	:	SUITE 3010
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2425
Country	:	US
Telephone Number	:	602-861-1168
Fax Number	:	602-861-1763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/25/2013

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Directions to “ WARREN MARK BREISBLATT MD” Practice Location

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