Provider Demographics
NPI:1770550709
Name:BREGE, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:BREGE
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 1:44720 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5480
Mailing Address - Country:US
Mailing Address - Phone:586-323-7148
Mailing Address - Fax:586-323-7215
Practice Address - Street 1:44720 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5480
Practice Address - Country:US
Practice Address - Phone:586-323-7148
Practice Address - Fax:586-323-7215
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBS GROUP NUMBER
MI4519658OtherAETNA
MI0500783OtherBCBS PIN NUMBER
MI1770550709Medicaid
MI4373558Medicaid
MI700E012740OtherBCBS GROUP NUMBER