Healthcare Provider Details

I. General information

NPI: 1770960007
Provider Name (Legal Business Name): WILLIAM ANDREW BREMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

904 BRIDLE LN
WHEATON IL
60187-3209
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax:
Mailing address:
  • Phone: 815-546-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036.146904
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.146904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: