Provider Demographics
NPI:1629079108
Name:BRECHNER, BRETT A (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:BRECHNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 E 109TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7687
Mailing Address - Country:US
Mailing Address - Phone:219-226-1529
Mailing Address - Fax:219-226-2994
Practice Address - Street 1:9150 E 109TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7687
Practice Address - Country:US
Practice Address - Phone:219-226-1529
Practice Address - Fax:219-226-2994
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002495A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200380090Medicaid
IN200380090Medicaid
H24197Medicare UPIN