Provider Demographics
NPI:1730145954
Name:BREKELBAUM, CHAD E (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:BREKELBAUM
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 1:5401 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8703
Mailing Address - Country:US
Mailing Address - Phone:479-521-8980
Mailing Address - Fax:479-521-1088
Practice Address - Street 1:5401 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8703
Practice Address - Country:US
Practice Address - Phone:479-521-8980
Practice Address - Fax:479-521-1088
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3636208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149759001Medicaid
AR149759001Medicaid
AR5M540Medicare ID - Type Unspecified