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General NPI Number Information
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NPI Number | 1437203528
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Entity Type | Individual
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Provider Name | BRUCE BRANTMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 626 BETHANY RD
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City | DEKALB
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State | IL
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Zip | 60115-4939
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Country | US
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Telephone | 815-756-1521
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Fax |
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Provider Business Mailing Address
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Address Line | 4029 N HARVARD AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-7949
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Country | US
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Telephone | 847-392-4684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036064606
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License Number State | IL
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