Provider Demographics
NPI:1407145840
Name:BREDEWEG, TERENCE DENNIS (DPM)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:DENNIS
Last Name:BREDEWEG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 TURWILL LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5225
Mailing Address - Country:US
Mailing Address - Phone:269-373-1019
Mailing Address - Fax:269-373-1669
Practice Address - Street 1:333 TURWILL LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5225
Practice Address - Country:US
Practice Address - Phone:269-373-1019
Practice Address - Fax:269-373-1669
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002416213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery