Healthcare Provider Details

I. General information

NPI: 1437139094
Provider Name (Legal Business Name): JOHN J BREMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD SUITE 107
ELGIN IL
60123-2306
US

IV. Provider business mailing address

1435 N RANDALL RD SUITE 107
ELGIN IL
60123-2306
US

V. Phone/Fax

Practice location:
  • Phone: 224-359-0100
  • Fax: 224-359-0120
Mailing address:
  • Phone: 224-359-0100
  • Fax: 224-359-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number036078342
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036078342
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036078342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: