Provider Demographics
NPI:1073603130
Name:BREENE, DENNIS P (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:BREENE
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 1:101 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1252
Mailing Address - Country:US
Mailing Address - Phone:815-625-4790
Mailing Address - Fax:
Practice Address - Street 1:2070 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4659
Practice Address - Country:US
Practice Address - Phone:770-622-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089915207W00000X
GA84184207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL012783OtherHEALTH ALLIANCE MEDICAL
IL9815737OtherBLUE CROSS
IL036089915Medicaid
IL012783OtherHEALTH ALLIANCE MEDICAL
ILL34513Medicare PIN