Provider Demographics
NPI:1902812746
Name:PESSANHA, BRENO S (MD)
Entity Type:Individual
Prefix:
First Name:BRENO
Middle Name:S
Last Name:PESSANHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:2200 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5503
Practice Address - Country:US
Practice Address - Phone:507-451-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066979A207RC0000X
IL036113769207RC0000X
MN61337207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000634666OtherBCBS BMG LAPORTE
ILIL01AAOtherJOHN DEERE
IN000000634708OtherBCBS BMG ADVANCED CARDIO SPECIALIST
IL0361137691Medicaid
IL108298OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
IL623711OtherHEALTHLINK
INP00788352OtherRR MEDICARE
IN200958590Medicaid
INP00835387OtherRR MEDICARE
IN000000644079OtherBCBS MEMORIAL HOSPITAL
IN000000635278OtherBCBS BMG SPECIALIST PLYMOUTH
IN257270HMedicare PIN
INP00788352OtherRR MEDICARE
IL7215059OtherBCBS PPO
ILI33189Medicare UPIN
INP00835387OtherRR MEDICARE
IN200958590Medicaid
IN941030C6Medicare PIN