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NPI Code Detail

MEDICARE: A DEN BREEIJEN M D P A

MEDICARE: A DEN BREEIJEN M D P A
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
12084P0800XPsychiatry PhysicianME0010918FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME0010918OTHERFLLICENSE

General Provider Information

NPI Number : 1417187808
Entity Type Code : Organization
Provider Name (Legal Business Name) : A DEN BREEIJEN M D P A
Provider Business Mailing Address
First Line : 1355 E MAIN ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5714
Country : US
Telephone Number : 368-682-8482
Fax Number : 863-684-3824
Provider Business Practice Location Address
First Line : 1355 E MAIN ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5714
Country : US
Telephone Number : 368-682-8482
Fax Number : 863-684-3824
Authorized Official
Title or Position : OWNER
Name : DR. ARIE DEN BREEIJEN
Credential : MD
Telephone Number : 863-682-8482
Provider Enumeration Date : 07/20/2009
Last Update Date : 07/21/2009

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Directions to “A DEN BREEIJEN M D P A ” Practice Location

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