Healthcare Provider Details

I. General information

NPI: 1801046958
Provider Name (Legal Business Name): MARSHALL F. BRUSTEIN M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W HAY ST SUITE 112
DECATUR IL
62526-6328
US

IV. Provider business mailing address

304 W HAY ST SUITE 112
DECATUR IL
62526-6328
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-8204
  • Fax:
Mailing address:
  • Phone: 217-872-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036104593
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056006099
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005019
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number036104593
License Number StateIL

VIII. Authorized Official

Name: DR. MARSHALL F. BRUSTEIN
Title or Position: OWNER
Credential: M.D.
Phone: 217-872-8204