Provider Demographics
NPI:1639159007
Name:BRETTSCHNEIDER, FRANK ALLAN (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ALLAN
Last Name:BRETTSCHNEIDER
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 1:1522 PINE GROVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3382
Mailing Address - Country:US
Mailing Address - Phone:810-982-3277
Mailing Address - Fax:810-982-0716
Practice Address - Street 1:1522 PINE GROVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3382
Practice Address - Country:US
Practice Address - Phone:810-982-3277
Practice Address - Fax:810-982-0716
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFB009336207Y00000X, 207YX0602X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040003270OtherRRMCR
MI0457410894OtherBCBS OF MICHIGAN
MI1620291003OtherCIGNA
MIE49534OtherHAP
MI4241715OtherAETNA
MI101313OtherCARE CHOICES
MIE49534Medicare UPIN
MIOM60020002Medicare PIN