MEDICARE: TERENCE DENNIS BREDEWEG D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	5901002416	MI

General Provider Information

NPI Number	:	1407145840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERENCE DENNIS BREDEWEG D.P.M.

Provider Business Mailing Address
First Line	:	333 TURWILL LN
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5225
Country	:	US
Telephone Number	:	269-373-1019
Fax Number	:	269-373-1669

Provider Business Practice Location Address
First Line	:	333 TURWILL LN
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-5225
Country	:	US
Telephone Number	:	269-373-1019
Fax Number	:	269-373-1669

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	10/15/2014

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