MEDICARE: WILLIAM BRESNIHAN

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	363AS0400X	Surgical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650272595	OTHER	FL	TAX ID

General Provider Information

NPI Number	:	1871765081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BRESNIHAN

Provider Business Mailing Address
First Line	:	PO BOX 450381
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33345-0381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 SE 6TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-3418
Country	:	US
Telephone Number	:	877-563-3374
Fax Number	:

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

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	05/08/2017

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