Healthcare Provider Details

I. General information

NPI: 1346278041
Provider Name (Legal Business Name): LAURENT BRARD MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 9TH ST STE 6W70
SPRINGFIELD IL
62702-5303
US

IV. Provider business mailing address

PO BOX 19640
SPRINGFIELD IL
62794-9640
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8882
  • Fax: 217-545-7958
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036127342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: