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General NPI Number Information
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NPI Number | 1669136453
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Entity Type | Individual
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Provider Name | WILLIAM J BRAMLETT PHD, CADC, CADP,MISA
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Gender | Male
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 11952 S HARLEM AVE STE 100
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1386
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Country | US
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Telephone | 708-923-0800
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Fax | 708-923-0700
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Provider Business Mailing Address
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Address Line | 11952 S HARLEM AVE STE 100
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1386
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Country | US
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Telephone | 708-923-0800
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Fax | 708-923-0700
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | A-4709-0002-A
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License Number State | IL
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