Provider Demographics
NPI:1659360675
Name:BREHM, BRADD (PA-C)
Entity Type:Individual
Prefix:
First Name:BRADD
Middle Name:
Last Name:BREHM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-227-7702
Mailing Address - Fax:419-227-7991
Practice Address - Street 1:951 COMMERCE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4040
Practice Address - Country:US
Practice Address - Phone:419-227-7702
Practice Address - Fax:419-227-7991
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50001362363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical