Provider Demographics
NPI:1770878092
Name:BRETZIUS, MICHELLE LYNN (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BRETZIUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1818
Mailing Address - Country:US
Mailing Address - Phone:302-300-3514
Mailing Address - Fax:949-437-3681
Practice Address - Street 1:306 POLK AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1818
Practice Address - Country:US
Practice Address - Phone:302-300-3514
Practice Address - Fax:949-437-3681
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0010831207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine