Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MT210713 | PA |
NPI | 1124465877 |
---|---|
Provider Name | Brett Barrett |
First Address | Oak Lawn, IL 60453-3054 |
Second Address | Oak Lawn, IL 60453-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125063479 | MEDICAL LICENSE, TEMPORARY (01) | IL |