Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016-002988-1 | IL |
NPI | 1073663217 |
---|---|
Provider Name | Dr. Barry A Brandes |
First Address | Oak Forest, IL 60452 |
Second Address | Oak Forest, IL 60452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37355 | (02) | IL |