Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901003968 | MI |
NPI | 1003974981 |
---|---|
Provider Name | Michael Steven Breza |
First Address | Clinton Twp, MI 48038-1644 |
Second Address | Clinton Twp, MI 48038-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003974981 | (05) | MI |
OE06315 | HEALTH ALLIANCE PLAN (01) | MI |
U75542 | (02) | MI |