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General NPI Number Information
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NPI Number | 1609228683
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Entity Type | Organization
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Legal Business Name | KURT J BROTHERSON
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 840 S WAUKEGAN RD 203
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City | LAKE FOREST
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State | IL
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Zip | 60045-2608
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Country | US
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Telephone | 847-482-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 840 S WAUKEGAN RD 203
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City | LAKE FOREST
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State | IL
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Zip | 60045-2608
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Country | US
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Telephone | 847-482-0136
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KURT J BROTHERSON
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Credential | M.D.
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Telephone | 847-482-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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