MEDICARE: DR. GERARD MARTIN BREITZER 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
1	208000000X	Pediatrics Physician	5101007628	MI

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

General Provider Information

NPI Number	:	1669414116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD MARTIN BREITZER D.O.

Provider Business Mailing Address
First Line	:	804 SERVICE RD
Second Line	:	A201
City	:	EAST LANSING
State	:	MI
Zip	:	48824-7015
Country	:	US
Telephone Number	:	517-884-2976
Fax Number	:	517-432-3928

Provider Business Practice Location Address
First Line	:	1600 W GRAND RIVER AVE
Second Line	:	STE 2
City	:	OKEMOS
State	:	MI
Zip	:	48864-2394
Country	:	US
Telephone Number	:	517-349-6560
Fax Number	:	517-349-5796

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	06/14/2016

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Directions to “ DR. GERARD MARTIN BREITZER D.O.” Practice Location

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