Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | IL |
NPI | 1053357590 |
---|---|
Provider Name | Dr. Sydney Raphael Brandwein |
First Address | Highland Park, IL 60035-5144 |
Second Address | Park Ridge, IL 60068-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G13510 | (02) |