Individual
DAVID G BREITWIESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9650 E WASHINGTON ST, STE 100, INDIANAPOLIS, IN 46229-3032
(317) 890-5500
(317) 890-5566
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028551A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100330320
—
IN
Enumeration date
06/21/2006
Last updated
02/21/2014
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