Provider Demographics
NPI:1750328605
Name:TRACY BRETL, D.O., S.C.
Entity Type:Organization
Organization Name:TRACY BRETL, D.O., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRETL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:414-351-1844
Mailing Address - Street 1:250 W COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3966
Mailing Address - Country:US
Mailing Address - Phone:414-351-8444
Mailing Address - Fax:414-351-0678
Practice Address - Street 1:250 W COVENTRY CT
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3972
Practice Address - Country:US
Practice Address - Phone:414-351-8444
Practice Address - Fax:414-351-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31707204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty