Provider Demographics
NPI:1629142955
Name:BREETZKE, CECIL BRIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:CECIL
Middle Name:BRIAN
Last Name:BREETZKE
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 1:1060 PEERLESS XING NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3784
Mailing Address - Country:US
Mailing Address - Phone:423-479-4165
Mailing Address - Fax:423-478-1884
Practice Address - Street 1:1060 PEERLESS XING NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3784
Practice Address - Country:US
Practice Address - Phone:423-479-4165
Practice Address - Fax:423-478-1884
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3895054Medicaid
TN4075200OtherBLUE CARE
TNTN0139OtherJOHN DEERE
G99401Medicare UPIN
TN3895054Medicare ID - Type Unspecified
TN3895054Medicaid