MEDICARE: MARK A. BRIEL 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	207V00000X	Obstetrics & Gynecology Physician	35050010	OH

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	:	1417946500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A. BRIEL MD

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	5TH FLOOR - CREDENTIALING
City	:	TOLEDO
State	:	OH
Zip	:	43604-7101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 EXECUTIVE PKWY
Second Line	:	SUITE 200
City	:	TOLEDO
State	:	OH
Zip	:	43606-1326
Country	:	US
Telephone Number	:	419-475-4666
Fax Number	:	419-486-8855

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/10/2016

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Directions to “ MARK A. BRIEL MD” Practice Location

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