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NPI Code Detail

MEDICARE: DR. TRACY LYNN BRETL D.O.

MEDICARE: DR. TRACY LYNN BRETL D.O.
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
1204D00000XNeuromusculoskeletal Medicine & OMM Physician31707-021WI

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 : 1447206388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY LYNN BRETL D.O.
Provider Business Mailing Address
First Line : 6793 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3422
Country : US
Telephone Number : 414-351-1844
Fax Number : 414-351-0678
Provider Business Practice Location Address
First Line : 6793 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3422
Country : US
Telephone Number : 414-351-1844
Fax Number : 414-351-0678
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 05/15/2012

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