Provider Demographics
NPI:1689713828
Name:NICOLAS BREUER MD PA
Entity Type:Organization
Organization Name:NICOLAS BREUER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-395-9200
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-395-9200
Mailing Address - Fax:561-347-1113
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-395-9200
Practice Address - Fax:561-347-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6127Medicare ID - Type UnspecifiedGROUP ID NUMBER