Individual
MICHAEL L BREITENFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
105 4TH AVENUE, SHELL L AKE, WI 54871-0336
(715) 468-2711
(715) 468-2727
Mailing address
105 4TH AVENUE, PO BOX 336, SHELL L AKE, WI 54871-0336
(715) 468-2711
(715) 468-2727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42906200
—
WI
Enumeration date
02/02/2007
Last updated
07/09/2007
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