MEDICARE: WARREN M BREITE 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	207RP1001X	Pulmonary Disease Physician	106261	MO
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	G9264	TX
3	207RP1001X	Pulmonary Disease Physician	01038424A	IN
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	075585	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110093731	OTHER	MO	MEDICARE RAILROAD

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457355372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN M BREITE MD

Provider Business Mailing Address
First Line	:	1390 HIGHWAY 61 STE 2300
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4121
Country	:	US
Telephone Number	:	636-937-3121
Fax Number	:	636-937-4423

Provider Business Practice Location Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 2300
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-937-3121
Fax Number	:	636-937-4423

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	01/28/2019

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Directions to “ WARREN M BREITE MD” Practice Location

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