Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD043247 | DC |
N | 208600000X | Surgeon | MD043247 | DC |
Y | 2086S0102X | Surgical Critical Care | 036158308 | IL |
N | 2086S0127X | Trauma Surgeon | MD043247 | DC |
NPI | 1063730083 |
---|---|
Provider Name | Dr. Bryan Phillip Hendren |
First Address | Skokie, IL 60076-5085 |
Second Address | Skokie, IL 60076-5085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2010 |
Last Update Date | 22/12/2021 |