Provider Demographics
NPI:1023002359
Name:BREIDENBACH, WARREN C (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:C
Last Name:BREIDENBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1846
Mailing Address - Country:US
Mailing Address - Phone:502-561-4359
Mailing Address - Fax:502-561-4221
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-561-4359
Practice Address - Fax:502-561-4221
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY230922082S0105X
IN01044787A2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230923Medicaid
IN100356120AMedicaid
IN218440AMedicare PIN
KY1264409Medicare PIN
KY400000341Medicare PIN
IN100356120AMedicaid
IN400000741Medicare PIN