Provider Demographics
NPI:1033470489
Name:BREGER, MARY T (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:BREGER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1496
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:7007 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2620
Practice Address - Country:US
Practice Address - Phone:414-352-3341
Practice Address - Fax:414-247-4588
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI26922-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30800900Medicaid
B51729Medicare UPIN