Provider Demographics
NPI:1720044472
Name:BREUING, KARL HEINZ (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:HEINZ
Last Name:BREUING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 ELLEFIELD STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-4318
Mailing Address - Fax:
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:STE 501
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-444-5495
Practice Address - Fax:401-444-5716
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD14821208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1720044472Medicaid
RIU400195512Medicare Oscar/Certification