Provider Demographics
NPI:1508444902
Name:CHANDRA, BREANA SARAH (MD)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:SARAH
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BREANA
Other - Middle Name:SARAH
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3678
Mailing Address - Country:US
Mailing Address - Phone:414-649-6732
Mailing Address - Fax:
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3678
Practice Address - Country:US
Practice Address - Phone:414-649-6732
Practice Address - Fax:414-649-5840
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI77939-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program