Provider Demographics
NPI:1194715854
Name:BREITWEISER, DAVID ALLEN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:BREITWEISER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S MURPHY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-8397
Mailing Address - Country:US
Mailing Address - Phone:812-442-2100
Mailing Address - Fax:812-446-4409
Practice Address - Street 1:115 S MURPHY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-8296
Practice Address - Country:US
Practice Address - Phone:812-442-2100
Practice Address - Fax:812-446-4409
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853600AMedicaid
IN200300810Medicaid
IN153869OtherRURAL HEALTH
IN200125280Medicaid
IN200853600AMedicaid
ING47639Medicare UPIN